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Phototherapy for Vitiligo

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Light-Based Therapies for Skin of Color

Abstract

The modern history of phototherapy began in 1801 when the German scientist JW Ritter isolated ultraviolet (UV) radiation. This knowledge was first utilized for dermatological therapeutic purposes in 1893 when Danish dermatologist Finsen used filtered sunlight to treat lupus vulgaris. The first employment of an artificial UV radiation source for the treatment of skin diseases came in 1894 when Lahman in Germany utilized the combination of a carbon arc lamp and a parabolic mirror to successfully treat lupus vulgaris. The transition from heliotherapy to phototherapy was solidified in 1901 when Finsen, who had replaced filtered sunlight with the carbon arc lamp for the treatment of lupus, published his results. Finsen won the Nobel Prize for medicine in 1903 for his work. He is recognized as the founder of modern phototherapy.2 Montgomery was the first to treat vitiligo with phototherapy in 1904 in the form of a Finsen light.3Although phototherapy had been established by this time as a legitimate therapeutic modality for some disorders, the low output of carbon arc lamps limited their usefulness. The journey toward a radiation source capable of higher output began with the development of the quartz lamp by the German Küch in 1906. The concept of using the quartz lamp for therapeutic purposes was spearheaded by Hagelschmidt in 1911. A quartz lamp with a high UV output was developed by Kromayer in 1912. The greatly increased UV output of this device significantly expanded the range of skin diseases that could be treated with phototherapy.

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References

  1. Millington GW, Levell NJ. Vitiligo: the historical curse of depigmentation. Int J Dermatol. 2007;46:990–995.

    Article  PubMed  Google Scholar 

  2. Roelandts R. The history of phototherapy: something new under the sun? J Am Acad Dermatol. 2002;46:926–930.

    Article  PubMed  Google Scholar 

  3. Kovacs SO. Vitiligo. J Am Acad Dermatol. 1998;38:647–666; quiz 667-668.

    Article  PubMed  CAS  Google Scholar 

  4. Halaban R, Langdon R, Birchall N, et al. Basic fibroblast growth factor from human keratinocytes is a natural mitogen for melanocytes. J Cell Biol. 1988;107:1611–1619.

    Article  PubMed  CAS  Google Scholar 

  5. Stierner U, Rosdahl I, Augustsson A, Kagedal B. UVB irradiation induces melanocyte increase in both exposed and shielded human skin. J Invest Dermatol. 1989;92:561–564.

    Article  PubMed  CAS  Google Scholar 

  6. Fitzpatrick TB. Mechanisms of phototherapy of vitiligo. Arch Dermatol. 1997;133:1591–1592.

    Article  PubMed  CAS  Google Scholar 

  7. Abdel-Naser MB, Hann SK, Bystryn JC. Oral psoralen with UV-A therapy releases circulating growth factor(s) that stimulates cell proliferation. Arch Dermatol. 1997;133:1530–1533.

    Article  PubMed  CAS  Google Scholar 

  8. Horikawa T, Norris DA, Johnson TW, et al. DOPA-negative melanocytes in the outer root sheath of human hair follicles express premelanosomal antigens but not a melanosomal antigen or the melanosome-associated glycoproteins tyrosinase, TRP-1, and TRP-2. J Invest Dermatol. 1996;106:28–35.

    Article  PubMed  CAS  Google Scholar 

  9. Falabella R. Surgical approaches for stable vitiligo. Dermatol Surg. 2005;31:1277–1284.

    Article  PubMed  CAS  Google Scholar 

  10. Duthie MS, Kimber I, Norval M. The effects of ultraviolet radiation on the human immune system. Br J Dermatol. 1999;140:995–1009.

    Article  PubMed  CAS  Google Scholar 

  11. Kulms D, Poppelmann B, Yarosh D, Luger TA, Krutmann J, Schwarz T. Nuclear and cell membrane effects contribute independently to the induction of apoptosis in human cells exposed to UVB radiation. Proc Natl Acad Sci U S A. 1999;96:7974–7979.

    Article  PubMed  CAS  Google Scholar 

  12. Aragane Y, Kulms D, Metze D, et al. Ultraviolet light induces apoptosis via direct activation of CD95 (Fas/APO-1) independently of its ligand CD95L. J Cell Biol. 1998;140:171–182.

    Article  PubMed  CAS  Google Scholar 

  13. Walters IB, Ozawa M, Cardinale I, et al. Narrowband (312-nm) UV-B suppresses interferon gamma and interleukin (IL) 12 and increases IL-4 transcripts: differential regulation of cytokines at the single-cell level. Arch Dermatol. 2003;139:155–161.

    Article  PubMed  CAS  Google Scholar 

  14. Morita A, Werfel T, Stege H, et al. Evidence that singlet oxygen-induced human T helper cell apoptosis is the basic mechanism of ultraviolet-A radiation phototherapy. J Exp Med. 1997;186:1763–1768.

    Article  PubMed  CAS  Google Scholar 

  15. Grimes PE. New insights and new therapies in vitiligo. JAMA. 2005;293:730–735.

    Article  PubMed  CAS  Google Scholar 

  16. Harris RP, Helfand M, Woolf SH, et al. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med. 2001;20:21–35.

    Article  PubMed  CAS  Google Scholar 

  17. Lim HW, Hexsel CL. Vitiligo: to treat or not to treat. Arch Dermatol. 2007;143:643–646.

    Article  PubMed  Google Scholar 

  18. Westerhof W, Nieuweboer-Krobotova L. Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. Arch Dermatol. 1997;133:1525–1528.

    Article  PubMed  CAS  Google Scholar 

  19. Yones SS, Palmer RA, Garibaldinos TM, Hawk JLM. Randomized double-blind trial of the treatment of vitiligo: efficacy of psoralen-UV-A therapy vs. narrowband UV-B therapy. Arch Dermatol. 2007.

    Google Scholar 

  20. Bhatnagar A, Kanwar AJ, Parsad D, De D. Comparison of systemic PUVA and NB-UVB in the treatment of vitiligo: an open prospective study. J Eur Acad Dermatol Venereol. 2007;21:638–642.

    Article  PubMed  CAS  Google Scholar 

  21. El Mofty M, Mostafa W, Esmat S, et al. Narrow band Ultraviolet B 311 nm in the treatment of vitiligo: two right-left comparison studies. Photodermatol Photoimmunol Photomed. 2006;22:6–11.

    Article  PubMed  CAS  Google Scholar 

  22. Sitek JC, Loeb M, Ronnevig JR. Narrowband UVB therapy for vitiligo: does the repigmentation last. J Eur Acad Dermatol Venereol. 2007;21:891–896.

    Article  PubMed  CAS  Google Scholar 

  23. Nicolaidou E, Antoniou C, Stratigos AJ, Stefanaki C, Katsambas AD. Efficacy, predictors of response, and long-term follow-up in patients with vitiligo treated with narrowband UVB phototherapy. J Am Acad Dermatol. 2007;56:274–278.

    Article  PubMed  Google Scholar 

  24. Anbar TS, Westerhof W, Abdel-Rahman AT, El-Khayyat MA. Evaluation of the effects of NB-UVB in both segmental and non-segmental vitiligo affecting different body sites. Photodermatol Photoimmunol Photomed. 2006;22:157–163.

    Article  PubMed  CAS  Google Scholar 

  25. Casacci M, Thomas P, Pacifico A, Bonnevalle A, Paro Vidolin A, Leone G. Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo – a multicentre controlled study. J Eur Acad Dermatol Venereol. 2007;21:956–963.

    Article  PubMed  CAS  Google Scholar 

  26. Njoo MD, Westerhof W, Bos JD, Bossuyt PM. A systematic review of autologous transplantation methods in vitiligo. Arch Dermatol. 1998;134:1543–1549.

    Article  PubMed  CAS  Google Scholar 

  27. Don P, Iuga A, Dacko A, Hardick K. Treatment of vitiligo with broadband ultraviolet B and vitamins. Int J Dermatol. 2006;45:63–65.

    Article  PubMed  Google Scholar 

  28. El-Mofty M, Mostafa W, Youssef R, et al. Ultraviolet A in vitiligo. Photodermatol Photoimmunol Photomed. 2006;22:214–216.

    Article  PubMed  Google Scholar 

  29. Hofer A, Hassan AS, Legat FJ, Kerl H, Wolf P. The efficacy of excimer laser (308 nm) for vitiligo at different body sites. J Eur Acad Dermatol Venereol. 2006;20:558–564.

    Article  PubMed  CAS  Google Scholar 

  30. Hofer A, Hassan AS, Legat FJ, Kerl H, Wolf P. Optimal weekly frequency of 308-nm excimer laser treatment in vitiligo patients. Br J Dermatol. 2005;152:981–985.

    Article  PubMed  CAS  Google Scholar 

  31. Hadi SM, Spencer JM, Lebwohl M. The use of the 308-nm excimer laser for the treatment of vitiligo. Dermatol Surg. 2004;30:983–986.

    Article  PubMed  Google Scholar 

  32. Lepe V, Moncada B, Castanedo-Cazares JP, Torres-Alvarez MB, Ortiz CA, Torres-Rubalcava AB. A double-blind randomized trial of 0.1% tacrolimus vs 0.05% clobetasol for the treatment of childhood vitiligo. Arch Dermatol. 2003;139:581–585.

    Article  PubMed  CAS  Google Scholar 

  33. Passeron T, Ostovari N, Zakaria W, et al. Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo. Arch Dermatol. 2004;140:1065–1069.

    Article  PubMed  CAS  Google Scholar 

  34. Fai D, Cassano N, Vena GA. Narrow-band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients. J Eur Acad Dermatol Venereol. 2007;21:916–920.

    Article  PubMed  CAS  Google Scholar 

  35. Yarosh DB, Pena AV, Nay SL, Canning MT, Brown DA. Calcineurin inhibitors decrease DNA repair and apoptosis in human keratinocytes following ultraviolet B irradiation. J Invest Dermatol. 2005;125:1020–1025.

    Article  PubMed  CAS  Google Scholar 

  36. Goldinger SM, Dummer R, Schmid P, Burg G, Seifert B, Lauchli S. Combination of 308-nm xenon chloride excimer laser and topical calcipotriol in vitiligo. J Eur Acad Dermatol Venereol. 2007;21:504–508.

    PubMed  CAS  Google Scholar 

  37. Arca E, Tastan HB, Erbil AH, Sezer E, Koc E, Kurumlu Z. Narrow-band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo. J Dermatol. 2006;33:338–343.

    Article  PubMed  CAS  Google Scholar 

  38. Kullavanijaya P, Lim HW. Topical calcipotriene and narrowband ultraviolet B in the treatment of vitiligo. Photodermatol Photoimmunol Photomed. 2004;20:248–251.

    Article  PubMed  CAS  Google Scholar 

  39. Goktas EO, Aydin F, Senturk N, Canturk MT, Turanli AY. Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo. J Eur Acad Dermatol Venereol. 2006;20:553–557.

    Article  PubMed  CAS  Google Scholar 

  40. Middelkamp-Hup MA, Bos JD, Rius-Diaz F, Gonzalez S, Westerhof W. Treatment of vitiligo vulgaris with narrow-band UVB and oral Polypodium leucotomos extract: a randomized double-blind placebo-controlled study. J Eur Acad Dermatol Venereol. 2007;21:942–950.

    Article  PubMed  CAS  Google Scholar 

  41. Zanolli M, Farr P. Phototherapy with UVB: broadband and narrowband. In: LimH W, Honigsmann H, Haek JLM. Photodermatology. New York, NY: Informa Healthcare USA; 2007:319–334.

    Google Scholar 

  42. Naldi L, Griffiths CE. Traditional therapies in the management of moderate to severe chronic plaque psoriasis: an assessment of the benefits and risks. Br J Dermatol. 2005;152:597–615.

    Article  PubMed  CAS  Google Scholar 

  43. Ibbotson SH, Bilsland D, Cox NH, et al. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol. 2004;151:283–297.

    Article  PubMed  CAS  Google Scholar 

  44. Stern RS, Lange R. Non-melanoma skin cancer occurring in patients treated with PUVA five to ten years after first treatment. J Invest Dermatol. 1988;91:120–124.

    Article  PubMed  CAS  Google Scholar 

  45. Nijsten TE, Stern RS. The increased risk of skin cancer is persistent after discontinuation of psoralen + ultraviolet A: a cohort study. J Invest Dermatol. 2003;121:252–258.

    Article  PubMed  CAS  Google Scholar 

  46. Stern RS. The risk of melanoma in association with long-term exposure to PUVA. J Am Acad Dermatol. 2001;44:755–761.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Multicultural Dermatology Center, Department of Dermatology, Henry Ford Medical Center – New Center One, Detroit, MI, 48202, USA

    Camile L. Hexsel, Richard H. Huggins & Henry W. Lim

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  1. Camile L. Hexsel
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  2. Richard H. Huggins
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  3. Henry W. Lim
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Correspondence to Henry W. Lim .

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    © 2009 Springer-Verlag London Limited

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    Hexsel, C.L., Huggins, R.H., Lim, H.W. (2009). Phototherapy for Vitiligo. In: Baron, E. (eds) Light-Based Therapies for Skin of Color. Springer, London. https://doi.org/10.1007/978-1-84882-328-0_6

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    • DOI: https://doi.org/10.1007/978-1-84882-328-0_6

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