The efficacy of photochemotherapy in Sri Lankan patients with vitiligo

Introduction: Photochemotherapy (PUVA) is one of the commonly used treatments for vitiligo.

Objective: To evaluate the efficacy of photochemotherapy in Sri Lankan patients with extensive and/or recalcitrant vitiligo.

Setting: Phototherapy Unit, National Hospital of Sri Lanka.

Methods: Vitiligo patients having >5% body surface area (BSA) involvement and/or refractory to other therapies, who attended our clinic during April - September 2006, were included in a prospective study. The percentage BSA involved was calculated using the palm of the hand (equivalent to 1%). The degree of depigmentation was determined using Vitiligo Area and Severity Scoring Index (VASI) visual scale.

Patients were irradiated with ultraviolet A using a Waldmann UV 7001 K phototherapy unit 2 hours after ingesting B-methoxypsoralen 0.5 mg/kg. Patients received PUVA twice a week, gradually increasing the UVA dose from 0.5 I / cm² up to a maximum of 6 J / cm². Response was evaluated at the end of 16, 24 and 32 sessions. VASI scores were calculated at the baseline and end of treatment.

Results: 12 patients (8 females), aged 28 - 58 years, with skin involvement ranging from 1.0 -17.7% (mean 7.7 ± SD 5.8) were included. At the end of 32 sessions, 10 patients (83%) had developed re-pigmentation, amounting to 2.5 – 21% (mean 11.1 ± SD 7) improvement in VASI relative to the baseline. The face and arms responded best. Hands and feet were resistant to therapy.

Nausea, erythema, irritation and hyperpigmentation were the common adverse effects reported. One patient had developed cataract.

Conclusion: Photochemotherapy is effective in initiating pigmentation in vitiligo patients with type IV - V skin. Its long-term efficacy and safety need to be determined.