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Phototherapy in Pigmentary Disorders

  • Thiam Seng Colin Theng
  • Eugene Sern-Ting Tan
Chapter
Part of the Updates in Clinical Dermatology book series (UCD)

Abstract

Phototherapy is an important treatment for pigmentary problems, in particular, for vitiligo, which is a common acquired depigmenting skin disease. PUVA therapy, both topical and systemic, has been a mainstay of treatment for years. However, PUVA is associated with an increase in skin malignancies especially with high cumulative sessions of phototherapy. In recent years, NBUVB and the excimer laser/lamp have become increasingly used as the main treatment modalities for vitiligo. The efficacy, relative ease of administration and lower skin carcinogenic risk have made these treatments the phototherapy treatment of choice. NBUVB is widely used for full body phototherapy, but targeted NBUVB devices are also available. Phototherapy with home hand-held phototherapy units has also been shown to have good efficacy with better adherence to treatment. The excimer laser and lamp emit UV light at wavelength of 308 nm and deliver targeted phototherapy. The phototherapy modalities can be combined with other modalities of treatment such as topical calcineurin inhibitors and calcipotriol for greater efficacy. Phototherapy still remains an important, safe and effective treatment for vitiligo.

Keywords

Phototherapy PUVA NBUVB Vitiligo Excimer laser Excimer lamp Targeted phototherapy Khellin Home phototherapy 

References

  1. 1.
    Ceoviae R, Pasiae A, Lipozenciase J, Jakiae-Razumoviae J, Szirovicza L, Kostoviae K. Antiproliferative, antiangiogenic, and apoptotic effect of photochemotherapy (PUVA) in psoriasis. Coll Anthropol. 2007;31:551–6.Google Scholar
  2. 2.
    Falabella R, Barona MI. Update on skin repigmentation therapies in vitiligo. Pigment Cell Melanoma Res. 2008;22:42–65.PubMedCrossRefGoogle Scholar
  3. 3.
    Wu CS, Lan CC, Wang LF, Chen GS, Wu CS, Yu HS. Effects of psoralen plus ultraviolet A irradiation on cultured epidermal cells in and patients with psoriasis in vivo. Br J Dermatol. 2007;156:122–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Ibbotson SH, Farr PM. The time-course of psoralen ultraviolet A (PUVA) erythema. J Invest Dermatol. 1999;113:346–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Kwok YK, Anstey AV, Hawk JL. Psoralen photochemotherapy (PUVA) is only moderately effective in widespread vitiligo: a 10-year retrospective study. Clin Exp Dermatol. 2002;27(2):104–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Tallab T, Joharji H, Bahamdan K, Karkashan E, Mourad M, Ibrahim K. Response of vitiligo to PUVA therapy in Saudi patients. Int J Dermatol. 2005;44(7):556–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Singh S, Khandpur S, Sharma VK, et al. Comparison of efficacy and side-effect profile of oral PUVA vs. oral PUVA sol in the treatment of vitiligo: a 36 week prospective study. J Eur Acad Dermatol Venereol. 2013;27(11):1344–51.PubMedCrossRefGoogle Scholar
  8. 8.
    Esmat SM, El-Tawdy AM, Hafez GA, et al. Acral lesions of vitiligo: why are they resistant to photochemotherapy. J Eur Acad Dermatol. 2012;26(9):1097–104.CrossRefGoogle Scholar
  9. 9.
    El Mofty M, Bosseila M, Mashaly HM, Gawdat H, Makaly H. Broadband ultraviolet A vs psoralen in the treatment of vitiligo: a randomized controlled trial. Clin Exp Dermatol. 2013;38(8):830–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Parsad D, Saini R, Verma N. Combination of PUVAsol and topical calcipotriol in vitiligo. Dermatology. 1998;197(2):167–70.PubMedCrossRefGoogle Scholar
  11. 11.
    Handa S, Pandhi R, Kaur I. Vitiligo: a retrospective comparative analysis of treatment modalities in 500 patients. J Dermatol. 2001;28:461–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Halpern SM, Anstey AV, Dawe RS, et al. Guidelines for topical PUVA: a report of a workshop of the British Photodermatology group. Br J Dermatol. 2000;142:22–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Valkova S, Trashlieva M, Christova P. Treatment of vitiligo with local khellin and UVA: comparison with systemic PUVA. Clin Exp Dermatol. 2004;29(2):180–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Ortel B, Tanew A, Honigsmann H. Treatment of vitiligo with khellin and ultraviolet A. J Am Acad Dermatol. 1998;90(5):720–4.Google Scholar
  15. 15.
    Duschet P, Schwartz T, Pusch M, Gschnait F. Marked increase of liver transaminases after Khellin and UVA therapy. J Am Acad Dermatol. 1989;21(3 Pt 1):592–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Morison WL, Marwaha S, Beck L. PUVA-induced phototoxicity: incidence and causes. J Am Acad Dermatol. 1997;36:183–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Ledbetter LS, Hsu S. Melanonychia associated with PUVA therapy. J Am Acad Dermatol. 2003;4:S31–2.CrossRefGoogle Scholar
  18. 18.
    Pathak MA, Mosher DB, Fitzpatrick TB. Safety and therapeutic effectiveness of 8 methoxy-psoralen4,5′,8-trimethlypsoralen, and psoralen in vitiligo. Natl Cancer Inst Monogr. 1984;66:165–73.PubMedGoogle Scholar
  19. 19.
    Stern RS, Laird N, Melski J, Parrish JA, Fitzpatrik TB, Bleich NL. Cutaneous squamous cell carcinoma in patients treated with oral methoxsalen photochemotherapy for psoriasis. N Engl J Med. 1984;310:1156–61.PubMedCrossRefGoogle Scholar
  20. 20.
    Nijsten TE, Stern RS. The increase risk of skin cancer is persistent after discontinuation of psoralen + ultraviolet A: a cohort study. J Invest Dermatol. 2003;121:252–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Stern RS, Nichols KT, Vakeva LH. Malignant melanoma in patients treated for psoriasis with methoxalen (psoralen) and ultraviolet A radiation (PUVA): the PUVA follow-up study. N England J Med. 1997;336:1041–5.CrossRefGoogle Scholar
  22. 22.
    Goekerman WH. The treatment of psoriasis. Northwest Med. 1925;24:229–31.Google Scholar
  23. 23.
    Fischer T. Comparative treatment of psoriasis with UV-light, trioxsalen plus UV-light, and coal tar plus UV-light. Acta Derm Venereol. 1977;57:345–50.PubMedGoogle Scholar
  24. 24.
    Bandow GD, Koo JY. Narrow-band ultraviolet B radiation: a review of the current literature. Int J Dermatol. 2004;43:555–61.PubMedCrossRefGoogle Scholar
  25. 25.
    Anderson RR, Parrish JA. The optics of human skin. J Invest Dermatol. 1981;77:13–9.PubMedCrossRefGoogle Scholar
  26. 26.
    el-Ghorr AA, Norval M. Biological effects of narrow-band (311 nm TL01) UVB irradiation: a review. J Photochem Photobiol B. 1997;38:99–106.PubMedCrossRefGoogle Scholar
  27. 27.
    Kao CH, Yu HS. Depletion and repopulation of Langerhans cells in nonsegmental type vitiligo. J Dermatol. 1990;17:287–96.PubMedCrossRefGoogle Scholar
  28. 28.
    Staricco RG, Miller-Milinska A. Activation of the amelanotic melanocytes in the outer root sheath of the hair follicle following ultra violet rays exposure. J Invest Dermatol. 1962;39:163–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Cui J, Shen LY, Wang GC. Role of hair follicles in the repigmentation of vitiligo. J Invest Dermatol. 1991;97:410–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Wu CS, Lan CC, Yu HS. Narrow-band UVB irradiation stimulates the migration and functional development of vitiligo-IgG antibodies-treated pigment cells. J Eur Acad Dermatol Venereol. 2012;26:456–64.PubMedCrossRefGoogle Scholar
  31. 31.
    Westerhof W, Nieuweboer-Krobotova L. Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. Arch Dermatol. 1997;133:1525–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Scherschun L, Kim JJ, Lim HW. Narrow-band ultraviolet B is a useful and well-tolerated treatment for vitiligo. J Am Acad Dermatol. 2001;44:999–1003.PubMedCrossRefGoogle Scholar
  33. 33.
    Hamzavi I, Jain H, McLean D, et al. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: the Vitiligo Area Scoring Index. Arch Dermatol. 2004;140:677–83.PubMedCrossRefGoogle Scholar
  34. 34.
    Natta R, Somsak T, Wisuttida T, et al. Narrowband ultraviolet B radiation therapy for recalcitrant vitiligo in Asians. J Am Acad Dermatol. 2003;49:473–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Njoo MD, Bos JD, Westerhof W. Treatment of generalized vitiligo in children with narrow-band (TL-01) UVB radiation therapy. J Am Acad Dermatol. 2000;42:245–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Kanwar AJ, Dogra S. Narrow-band UVB for the treatment of generalized vitiligo in children. Clin Exp Dermatol. 2005;30:332–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Yones SS, Palmer RA, Garibaldinos TM, et al. Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UV-A therapy vs narrowband-UV-B therapy. Arch Dermatol. 2007;143:578–84.PubMedCrossRefGoogle Scholar
  38. 38.
    Jekler J, Larkö O. Vitiligo treatment in childhood: a state of the art review. Pediatr Dermatol. 2010;27:437–45.CrossRefGoogle Scholar
  39. 39.
    Casacci M, Thomas P, Pacifico A, et al. 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;21:956–63.PubMedCrossRefGoogle Scholar
  40. 40.
    Verhaeghe E, Lodewick E, van Geel N, et al. Intrapatient comparison of 308-nm monochromatic excimer light and localized narrow-band UVB phototherapy in the treatment of vitiligo: a randomized controlled trial. Dermatology. 2011;223:343–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Lopes C, Trevisani VF, Melnik T. Efficacy and safety of 308-nm monochromatic excimer lamp versus other phototherapy devices for vitiligo: a systematic review with meta-analysis. Am J Clin Dermatol. 2016;17:23–32.PubMedCrossRefGoogle Scholar
  42. 42.
    Wong R, Lin AN. Efficacy of topical calcineurin inhibitors in vitiligo. Int J Dermatol. 2013;52:491–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Majid I. Does topical tacrolimus ointment enhance the efficacy of narrowband ultraviolet B therapy in vitiligo? A left-right comparison study. Photodermatol Photoimmunol Photomed. 2010;26:230–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Esfandiarpour I, Ekhlasi A, Farajzadeh S, et al. The efficacy of pimecrolimus 1% cream plus narrow-band ultraviolet B in the treatment of vitiligo: a double-blind, placebo-controlled clinical trial. J Dermatolog Treat. 2009;20:14–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Goktas EO, Aydin F, Senturk N, et al. Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo. J Eur Acad Dermatol Venereol. 2006;20:553–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Leone G, Pacifico A, Iacovelli P, et al. Tacalcitol and narrow-band phototherapy in patients with vitiligo. Clin Exp Dermatol. 2006;31:200–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Ada S, Sahin S, Boztepe G, et al. No additional effect of topical calcipotriol on narrow-band UVB phototherapy in patients with generalized vitiligo. Photodermatol Photoimmunol Photomed. 2005;21:79–83.PubMedCrossRefGoogle Scholar
  48. 48.
    Arca E, Taştan HB, Erbil AH, et al. Narrow-band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo. J Dermatol. 2006;33:338–43.PubMedCrossRefGoogle Scholar
  49. 49.
    Khullar G, Kanwar AJ, Singh S, et al. Comparison of efficacy and safety profile of topical calcipotriol ointment in combination with NB-UVB vs. NB-UVB alone in the treatment of vitiligo: a 24-week prospective right-left comparative clinical trial. J Eur Acad Dermatol Venereol. 2015;29:925–32.PubMedCrossRefGoogle Scholar
  50. 50.
    Westerhof W, d’Ischia M. Vitiligo puzzle: the pieces fall in place. Pigment Cell Res. 2007;20:345–59.PubMedGoogle Scholar
  51. 51.
    Choudhry SZ, Bhatia N, Ceilley R, et al. Role of oral Polypodium leucotomos extract in dermatologic diseases: a review of the literature. J Drugs Dermatol. 2014;13:148–53.PubMedGoogle Scholar
  52. 52.
    Middelkamp-Hup MA, Bos JD, Rius-Diaz F, et al. 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;21:942–50.PubMedCrossRefGoogle Scholar
  53. 53.
    Winkelmann RR, Del Rosso J, Rigel DS. Polypodium leucotomos extract: a status report on clinical efficacy and safety. J Drugs Dermatol. 2015;14:254–61.PubMedGoogle Scholar
  54. 54.
    Elgoweini M, Nour El Din N. Response of vitiligo to narrowband ultraviolet B and oral antioxidants. J Clin Pharmacol. 2009;49:852–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Dell’Anna ML, Mastrofrancesco A, Sala R, et al. Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol. 2007;32:631–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Thody AJ. Alpha-MSH and the regulation of melanocyte function. Ann N Y Acad Sci. 1999;885:217–29.PubMedCrossRefGoogle Scholar
  57. 57.
    Fabrikant J, Touloei K, Brown SM. A review and update on melanocyte stimulating hormone therapy: afamelanotide. J Drugs Dermatol. 2013;12:775–9.PubMedGoogle Scholar
  58. 58.
    Lim HW, Grimes PE, Agbai O, et al. Afamelanotide and narrowband UV-B phototherapy for the treatment of vitiligo: a randomized multicenter trial. JAMA Dermatol. 2015;151:42–50.PubMedCrossRefGoogle Scholar
  59. 59.
    Nicolaidou E, Antoniou C, Stratigos AJ, et al. Efficacy, predictors of response, and long-term follow-up in patients with vitiligo treated with narrowband UVB phototherapy. J Am Acad Dermatol. 2007;56:274–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Brazzelli V, Antoninetti M, Palazzini S, et al. Critical evaluation of the variants influencing the clinical response of vitiligo: study of 60 cases treated with ultraviolet B narrow-band phototherapy. J Eur Acad Dermatol Venereol. 2007;21:1369–74.PubMedCrossRefGoogle Scholar
  61. 61.
    Hallaji Z, Ghiasi M, Eisazadeh A, et al. Evaluation of the effect of disease duration in generalized vitiligo on its clinical response to narrowband ultraviolet B phototherapy. Photodermatol Photoimmunol Photomed. 2012;28:115–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Sitek JC, Loeb M, Ronnevig JR. Narrowband UVB therapy for vitiligo: does the repigmentation last? J Eur Acad Dermatol Venereol. 2007;21:891–6.PubMedCrossRefGoogle Scholar
  63. 63.
    Guillet G, Helenon R, Gauthier Y, et al. Progressive macular hypomelanosis of the trunk: primary acquired hypopigmentation. J Cutan Pathol. 1988;15:286–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Relyveld GN, Menke HE, Westerhof W. Progressive macular hypomelanosis: an overview. Am J Clin Dermatol. 2007;8:13–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Santos JB, Almeida OL, Silva LM, et al. Efficacy of topical combination of benzoyl peroxide 5% and clindamycin 1% for the treatment of progressive macular hypomelanosis: a randomized, double-blind, placebo-controlled trial. An Bras Dermatol. 2011;86:50–4.PubMedCrossRefGoogle Scholar
  66. 66.
    Thng ST, Long VS, Chuah SY, et al. Efficacy and relapse rates of different treatment modalities for progressive macular hypomelanosis. Indian J Dermatol Venereol Leprol. 2016;82:673–6.PubMedCrossRefGoogle Scholar
  67. 67.
    Sim JH, Lee DJ, Lee JS, et al. Comparison of the clinical efficacy of NBUVB and NBUVB with benzoyl peroxide/clindamycin in progressive macular hypomelanosis. J Eur Acad Dermatol Venereol. 2011;25:1318–23.PubMedCrossRefGoogle Scholar
  68. 68.
    Kim MB, Kim GW, Cho HH, et al. Narrowband UVB treatment of progressive macular hypomelanosis. J Am Acad Dermatol. 2012;66:598–605.PubMedCrossRefGoogle Scholar
  69. 69.
    Duarte I, Nina BI, Gordiano MC, et al. Progressive macular hypomelanosis: an epidemiological study and therapeutic response to phototherapy. An Bras Dermatol. 2010;85:621–4.PubMedCrossRefGoogle Scholar
  70. 70.
    Bilsland D, Dawe RS. Ultraviolet phototherapy and photochemotherapy of skin disease. In: Ferguson J, Dover JS, editors. Photodermatology. London: Manson Publishing Ltd; 1996. p. 113–24.Google Scholar
  71. 71.
    Zanolli MD, Feldman SR. Phototherapy treatment protocols for psoriasis and other phototherapy-responsive dermatoses. New York: Taylor & Francis Group; 2004.Google Scholar
  72. 72.
    Madigan LM, Al-Jamal M, Hamzavi I. Exploring the gaps in the evidence-based application of narrowband UVB for the treatment of vitiligo. Photodermatol Photoimmunol Photomed. 2016;32:66–80.PubMedCrossRefGoogle Scholar
  73. 73.
    Kist JM, Van Voorhees AS. Narrowband ultraviolet B therapy for psoriasis and other skin disorders. Adv Dermatol. 2005;21:235–50.PubMedCrossRefGoogle Scholar
  74. 74.
    Hexsel CL, Mahmoud BH, Mitchell D, et al. A clinical trial and molecular study of photoadaptation in vitiligo. Br J Dermatol. 2009;160:534–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Schneider LA, Hinrichs R, Scharffetter-Kochanek K. Phototherapy and photochemotherapy. Clin Dermatol. 2008;26:464–76.PubMedCrossRefGoogle Scholar
  76. 76.
    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;151:283–97.PubMedCrossRefGoogle Scholar
  77. 77.
    de Gruijl FR, Rebel H. Early events in UV carcinogenesis – DNA damage, target cells and mutant p53 foci. Photochem Photobiol. 2008;84:382–7.PubMedCrossRefGoogle Scholar
  78. 78.
    Cooper SJ, Bowden GT. Ultraviolet B regulation of transcription factor families: roles of nuclear factor-kappa B (NF-kappaB) and activator protein-1 (AP-1) in UVB-induced skin carcinogenesis. Curr Cancer Drug Targets. 2007;7:325–34.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Bishop DT, Demenais F, Iles MM, et al. Genome-wide association study identifies three loci associated with melanoma risk. Nat Genet. 2009;41:920–5.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Jin Y, Birlea SA, Fain PR, et al. Variant of TYR and autoimmunity susceptibility loci in generalized vitiligo. N Engl J Med. 2010;362:1686–97.PubMedPubMedCentralCrossRefGoogle Scholar
  81. 81.
    Teulings HE, Overkamp M, Ceylan E, et al. Decreased risk of melanoma and nonmelanoma skin cancer in patients with vitiligo: a survey among 1307 patients and their partners. Br J Dermatol. 2013;168:162–71.PubMedCrossRefGoogle Scholar
  82. 82.
    Paradisi A, Tabolli S, Didona B, et al. Markedly reduced incidence of melanoma and nonmelanoma skin cancer in a nonconcurrent cohort of 10,040 patients with vitiligo. J Am Acad Dermatol. 2014;71:1110–6.PubMedCrossRefGoogle Scholar
  83. 83.
    Shan X, Wang C, Tian H, Yang B, Zhang F. Narrow-band ultraviolet B home phototherapy for vitiligo. Indian J Dermatol Venereol Lepro. 2014;80(4):336–8.CrossRefGoogle Scholar
  84. 84.
    Tien Guan ST, Theng C, Chang A. Randomized, parallel group trial comparing home-based phototherapy with institution-based 308 excimer lamp for the treatment of focal vitiligo vulgaris. J Am Acad Dermatol. 2015;72(4):733–73.PubMedCrossRefGoogle Scholar
  85. 85.
    Baltas E, Csoma Z, Ignacz F, et al. Treatment of vitiligo with the 308-nm xenon chloride excimer laser. Arch Dermatol. 2002;138:1619–20.PubMedCrossRefGoogle Scholar
  86. 86.
    Hadi SM, Spencer JM, Lebwohl M. Treatment of vitiligo using the 308-nm excimer laser for the treatment of vitiligo. Dermatol Surg. 2004;30(7):983–6.PubMedGoogle Scholar
  87. 87.
    Hadi S, Tinio P, Al-Ghaithi K, Al-Quari H, Al-Helalat M, Lebwohl M, Spencer J. Treatment of vitiligo using the 308nm excimer laser. Photomed Laser Surg. 2006;24:354–7.PubMedCrossRefGoogle Scholar
  88. 88.
    Zhang XY, He LY, Dong J, et al. Clinical efficacy of the 308-nm excimer laser in the treatment of vitiligo. Photodermatol Photoimmunol Photomed. 2010;26:138–42.PubMedCrossRefGoogle Scholar
  89. 89.
    Hofer A, Hassan AS, Legat FJ, et al. The efficacy of excimer laser (308 nm) for vitiligo at different body sites. J Eur Acad Dermatol Venereol. 2006;20:558–64.PubMedCrossRefGoogle Scholar
  90. 90.
    Al-Otaibi SR, Zadeh VB, Al-Abdulrazzaq AH, et al. Using a 308-nm excimer laser to treat vitiligo in Asians. Acta Dermatovenereol Alp Panonica Adriat. 2009;18(1):13–9.Google Scholar
  91. 91.
    Fa Y, Lin Y, Chi WH, et al. Treatment of vitiligo with 308-nm excimer laser: our experience from a 2 year follow-up of 979 Chinese patients. J Eur Acad Dermatol Venereol. 2017;31(2):337–40.PubMedCrossRefGoogle Scholar
  92. 92.
    Le Duff F, Fontas E, Giacchero D, et al. 308 excimer lamp vs 308-nm excimer laser for treating vitiligo: a randomized study. Br J Dermatol. 2010;163:188–92.PubMedGoogle Scholar
  93. 93.
    Shi Q, Li K, Fu J, Wang Y, Ma C, Li Q, Li C, Gao T. Comparison of the 308-nm ecimer laser with the 308-nm excimer lamp in the treatment of vitiligo – a randomized bilateral comparison study. Photodermatol Photoimmunol Photomed. 2013;29(1):27–33.PubMedCrossRefGoogle Scholar
  94. 94.
    Lopes C, Trevisanni VF, Melnik T. Efficacy and safety of 308-nm monochromatic Excimer lamp versus other phototherapy devices for vitiligo: a systemic review and meta-analysis. Am J Dermatol. 2016;17(1):23–32.CrossRefGoogle Scholar
  95. 95.
    Kawalek AZ, Spencer JM, Phelps RG. Combined excimer laser and topical tacrolimus for the treatment of vitiligo: a pilot study. Dermatol Surg. 2004;30(2Pt1):130–5.PubMedGoogle Scholar
  96. 96.
    Passeron T, Ostovari N, Zakaria W, Fontas E, Larrouv JC, Lacour JP, Ortonne JP. Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo. Arch Dermatol. 2004;140(9):1065–9.PubMedCrossRefGoogle Scholar
  97. 97.
    Nistico S, Chiricozzi A, Saraceno R, Schipani C, Chimenti S. Vitiligo treatment with monochromatic excimer light and tacrolimus: results of an open randomized controlled study. Photomed Laser Surg. 2012;30(1):26–30.PubMedCrossRefGoogle Scholar
  98. 98.
    Matin M, Latifi S, Zoufan N, Koushki D, Mirhafari Daryasari SA, Rahdari F. The effectiveness of excimer laser on vitiligo treatment in comparison with a combination therapy of Excimer laser and tacrolimus in an Iranian population. J Cosmet Laser Ther. 2014;16(5):241–5.PubMedCrossRefGoogle Scholar
  99. 99.
    Park OJ, Park GH, Choi JR, Jung HJ, ES O, Choi JH, Lee MW, Chang SE. A combination of excimer laser treatment and topical tacrolimus is more effective in treating vitiligo than either therapy alone for the initial 6 months, but not thereafter. Clin Exp Dermatol. 2016;41(3):236–41.PubMedCrossRefGoogle Scholar
  100. 100.
    Hui-Lan Y, Xiao-Yan H, Jian-Yong F, Zong-Rong L. Combination of 308-nm excimer laser with topical pimecrolimus for the treatment of childhood vitiligo. Paediatr Dermatol. 2009;26(3):354–6.CrossRefGoogle Scholar
  101. 101.
    Bae JM, Hong BY, Lee JH, Lee JH, Kim GM. The efficacy of 308-nm excimer laser/light (EL) and topical agent combination therapy versus EL monotherapy for vitiligo: a systematic review and meta-analysis of randomized controlled trials (RCTs). J Am Acad Dermatol. 2016;74(5):907–15.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Thiam Seng Colin Theng
    • 1
  • Eugene Sern-Ting Tan
    • 2
  1. 1.The Skin Specialists & Medical Clinic, Mount Alvernia Medical DSingaporeSingapore
  2. 2.Department of DermatologyNational Skin CentreSingaporeSingapore

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