Phototherapy in vitiligo: a comparative evaluation of various therapeutic modalities

Phototherapy is the backbone of vitiligo treatment. Besides the use of heliotherapy since ancient times, artificial sources have been introduced for the last decades in different wavelengths and administration devices utilizing a multitude of regimens and treatment combinations. In this article, we present a comprehensive compilation of the use of different modalities of phototherapy in vitiligo on the basis of a multitude of related comparative studies that have been carried out during the last decade, including those performed at the Phototherapy Unit, Kasr Al Aini Hospital. The phototherapeutic modality most commonly utilized in the treatment of vitiligo at present is narrowband ultraviolet B (NB-UVB) (311 nm), although in our area, photochemotherapy still continues to be used. Efforts have been made to take into account most comparative studies including the different combinations of NB-UVB with other modalities. The different types of psoralens used in photochemotherapy are discussed, besides comparison of the use of various ultraviolet light sources in vitiligo. The results of studies comparing both psoralen plus ultraviolet A and NB-UVB are also included. A more recently emerging phototherapeutic modality in the treatment of vitiligo and other photoresponsive dermatoses is broadband UVA, which awaits shortterm and long-term safety evaluation studies, both clinical and laboratory. Diverse tools yielding targeted phototherapy are widely being used nowadays in the treatment of vitiligo. Systems range from laser to incoherent pointed light equipment to larger but localized sources, all aiming at sparing the unaffected skin undue radiation exposure.