Phototherapy (also known as light therapy) is a safe and effective treatment that can help with repigmentation and stabilization of vitiligo by exposing vitiligo patches to ultraviolent (UV) light. Some types of phototherapy treatments are only available in a dermatologist’s clinic, while others types can be done at home under the direction of a prescribing physician.
There are four types of phototherapy treatments for vitiligo:
Narrowband-UVB, now considered the gold standard of treatment for vitiligo, uses the portion of the UVB spectrum from 311-313 nm. This light spectrum has been determined to help stimulate the melanocytes (pigment making cells) in less time than it takes to burn the skin. NB-UVB is sometimes used in combination with other topical treatments, but is effective for many on its own. NB-UVB can be used on children old enough to stand still and keep goggles on.
NB-UVB is usually done 2-3 times a week. Home NB-UVB therapy is effective option for individuals who find frequent clinic visits to be difficult or impossible. It is extremely important that home phototherapy usage be done in strict adherence with dose and scheduling instructions.
Repigmentation usually appears after about 24 sessions, but maximum improvement may take 1-2 years.
The excimer laser is a targeted NB machine typically using the 308 nm portion of the UVB spectrum. Laser can be very effective for smaller areas of stable vitiligo. As it treats a small area, it is inefficient for larger areas or percentages.
Results from laser treatments frequently occur more quickly than with other treatments. Because laser treatments are expensive, it is typically only used on stable vitiligo, because when the vitiligo is active there is a greater chance of pigment being lost afterwards. Hands and feet are often not treated with laser because it is less effective there. Treatments are generally 2-3 times per week.
PUVA stands for Psoralen plus UltraViolet A light, and is a form of phototherapy using long wave UVA light in combination with either a photosensitizing (making more sensitive to the effects of light) pill or a topical solution known as a psoralen. When using the pill form, the psoralen sensitizes the skin and eyes for up to 24 hours. To prevent the risk of cataracts, patients must wear approved wraparound sunglasses, indoors and out, for up to 24 hours after taking the tablets. PUVA is generally considered a less effective therapy, with more side effects, than NB-UVB.
For patients who cannot go to a facility with a UVA lightbox, the doctor may prescribe psoralen to be used with natural sunlight exposure. The doctor will give the patient careful instructions on carrying out treatment at home and monitor the patient during scheduled checkups.
PUVASOL is not used very much in the USA anymore due to the discontinuation of trioxsalen in 2002.
What about sunlight or tanning beds?
Sunlight is not an effective option for repigmentation. Vitiligo patches are very susceptible to sunburn. Prescription NB-UVB therapy avoids the UVA in sunlight that causes sunburn, skin cancer, and premature aging of the skin.
Tanning beds or other indoor tanning devices should be avoided.
Some insurance companies require the attestation of a physician before approving coverage of phototherapy for the treatment of vitiligo. GVF offers resources to make this process easier for physicians and patients.
Resources Disclaimer: The information provided on this page and in the linked resources should only be used under the guidance of your physician or another licensed medical professional. Use your phototherapy device as you would any prescription medication under the direction of a physician. Like any medication, phototherapy can be harmful if not used properly.