UVB-Narrowband light therapy promotes vitiligo repigmentation in at least four ways:
Boosts Vitamin D Levels
Increasing the patient’s Vitamin D levels, which is also best achieved by exposing as much skin area as possible to the UVB light.
Stimulates Melanocyte Stem Cells
Within the vitiligo lesions, by stimulating the melanocyte stem cells so that new melanocytes are created.
Stimulates Dormant Melanocytes
Within the vitiligo lesions, by stimulating the atrophied melanocytes so they produce melanin pigment again.
Suppresses Overactive Immune System
A general suppression of the patient’s overactive immune system, which is best achieved by exposing as much skin area as possible to the UVB light (and thus best done using a full body phototherapy device).
Considered worldwide as the gold standard for vitiligo treatment UVB-Narrowband (UVB-NB) phototherapy is a light therapy procedure in which the patient’s skin is exposed only to the wavelengths of ultraviolet light medically studied to be the most beneficial (around 311 nanometers using Philips /01 medical fluorescent lamps), and usually without any drugs.
The objective for each phototherapy treatment is to take just enough UVB‑Narrowband so that within at least one vitiligo lesion a very mild pink color is observed four to twelve hours after the treatment. The dose necessary for this is known as the Minimum Erythema Dose or “MED”. If the MED is exceeded, the skin will burn and reduce the treatment’s effectiveness. Once the MED has been established, the same dose is used for all subsequent treatments unless the results after treatment change, in which case the dose is adjusted accordingly. Some areas of the body such as hands and feet typically have a larger MED than other areas of the body, so for best results, after the primary full-body treatment is given, these areas should be targeted for a larger dose by providing extra treatment time to those areas only, for example by taking special body positions as shown.
To determine a new patient’s MED and speed up the treatment schedule, some phototherapy clinics will use a MED patch testing device that allows various UVB-Narrowband doses be delivered to several small skin areas at the same time, and evaluate the results after four to twelve hours. Other clinics and the method preferred for SolRx home phototherapy, is to gradually build up the UVB-Narrowband dose using established treatment protocols (included in the SolRx User’s Manual) until MED is evident. For example, a SolRx 1780UVB-NB has an initial (starting) treatment time of 40 seconds per side with the skin eight to twelve inches from the light bulbs, and for each treatment that does not result in MED, the next treatment time is increased by 10 seconds. The patient is thus eased into the correct MED with minimal risk sunburn or an incorrect initial MED. The same protocol is used regardless of the patient’s primary skin type: light or dark.
For a SolRx 1780UVB-NB the final MED treatment time typically ranges from one to three minutes per side for segmental vitiligo, and two to four minutes per side for non-segmental vitiligo. Treatments are usually taken twice per week, but never on consecutive days. In some cases every second day has proved successful. During treatment the patient must wear the UV protective goggles supplied; unless the eyelids are affected, in which case treatment without goggles can proceed if the eyelids are held closed tightly (eyelid skin is thick enough to block any UV from entering the eye). Also, unless affected, males should cover both their penis and scrotum using a sock. Topical drugs, with the exception of pseudocatalase, should be applied only after UVB-Narrowband treatment to avoid light blockage, adverse skin reactions and possible UV deactivation of the drug. After several weeks of diligent treatments the patient’s MED time will be established and within a few months the first signs of repigmentation will appear in most patients. With patience and consistency many patients can achieve complete repigmentation, but it can take twelve to eighteen months or more, with six-foot high full-body devices proving more successful than smaller devices for the reasons listed above.
During repigmentation, sometimes the surrounding healthy skin further darkens as its melanocytes also respond to the treatments, and especially if they are exposed to natural sunlight, which contains far more of the UVA tanning wavelengths than the beneficial UVB wavelengths. To reduce the resulting contrast between lesion and healthy skin, and to avoid sunburn, UVB-Narrowband phototherapy patients should minimize their exposure to natural sunlight by avoiding the sun or using a sunblock (high-SPF sunscreen). If sunblock is used the skin should be washed the day before phototherapy treatment to ensure it does not block the beneficial UVB-Narrowband light. As treatments continue the contrast between lesion and healthy skin will gradually fade.
After repigmentation, sometimes the opposite happens as the newly repigmented lesions may initially be darker than the surrounding healthy skin, a result of the new melanocytes producing more melanin than the old melanocytes when exposed to the same amount of stimulating UV light. This is normal and the contrast will also gradually fade so that within months of continued treatments the patient’s skin tone will become more well blended.
For an interesting video illustrating the UVB-Narrowband repigmentation process for vitiligo, consider watching this video produced by Clinuvel in Australia:
With UVB-Narrowband light therapy, typically the face and neck are the first areas to respond, followed closely by the rest of the body. The hands and feet are typically the most difficult parts of the body to repigment, especially if the vitiligo is well established. To have the best chance of repigmentation, vitiligo patients should begin vitiligo treatments as soon as possible.
After repigmentation has been achieved, some non-segmental vitiligo patients may have lesions reappear over the coming months or years. To help prevent this, patients should consider ongoing and ideally full-body UVB-Narrowband maintenance treatments at a reduced dose and frequency. Doing so helps to keep the immune system under control and protects the melanocytes from renewed attack, while making large amounts of Vitamin D naturally within the skin.
In practice, UVB-NB phototherapy is effective in hospital and dermatologist phototherapy clinics (of which there are about 1000 in USA, and 100 publically funded in Canada), and equally well in the patient’s home. Hundreds of medical studies have been published – a search on the USA Government’s respected PubMed website for “Narrowband UVB” will return more than 400 listings!
Home UVB-Narrowband phototherapy has proven effective because, even though the devices used are typically smaller and have fewer bulbs than those at the phototherapy clinic, home units use the exact same part numbers of Philips UVB-NB bulbs, so the only practical difference is somewhat longer treatment times to achieve the same dose and the same results. Compared to clinical phototherapy, the convenience of home treatments has many advantages, including great time and travel savings, easier treatment scheduling (fewer missed treatments), privacy, and the ability to continue maintenance treatments after repigmentation is achieved, instead of being discharged by the clinic and letting the vitiligo return. Solarc believes that ongoing UVB-Narrowband treatments are an excellent long-term solution for vitiligo control.