NB-UVB Protocol for Vitiligo
NB-UVB phototherapy should be administered three times per week on non-consecutive days, with treatment reserved for patients with widespread vitiligo or localized disease significantly impacting quality of life, ideally in darker skin types (IV-VI). 1
Patient Selection Criteria
Best candidates for NB-UVB therapy:
- Patients with widespread vitiligo or localized disease with significant QOL impact 1
- Darker skin types (IV-VI) where depigmentation is most visible and distressing 1, 2
- Children or adults who have failed more conservative treatments (topical corticosteroids or calcineurin inhibitors) 1, 3
- Patients without contraindications to phototherapy 1
Treatment Protocol
Frequency and Duration:
- Administer treatments three times weekly on non-consecutive days (standard convention) 1
- Continue for up to one year or until adequate repigmentation is achieved 4
- Onset of repigmentation typically occurs by the 3rd to 10th treatment session 5
Safety Limits:
- Maximum 200 treatments for skin types I-III (arbitrary but recommended limit due to increased photodamage risk in depigmented skin) 1
- Higher cumulative doses may be considered for skin types IV-VI at clinician discretion with patient consent 1
- Mean total doses around 201 J/cm² have been reported in successful protocols 4
Expected Outcomes and Response Patterns
Efficacy data:
- 36% of patients maintain >75% repigmentation at 12-month follow-up (superior to PUVA's 24%) 1
- Approximately 77.5% of patients achieve some degree of repigmentation (50-100%) 5
- 41.9% achieve marked to complete repigmentation 6
Site-specific responses:
- Best response: Face and neck (up to 65% of lesions achieve 90-100% repigmentation) 5
- Poor response: Hands and feet respond poorly in all patients 1
- Non-acral areas respond significantly better than acral sites 4
Prognostic factors for better response:
- Recent onset vitiligo (shorter disease duration) 4
- No previous treatment exposure 4
- Negative family history for vitiligo 4
- Focal vitiligo pattern 7
Monitoring Protocol
Assessment schedule:
- Document baseline disease extent with photographs using VASI or VETF scoring systems 3
- Evaluate repigmentation every 2-3 months with serial photographs for objective assessment 2, 8
- Monitor for adverse effects at each visit 4, 7
Advantages Over PUVA
NB-UVB is superior to oral PUVA based on Level 1+ evidence:
- Better color match with surrounding skin 6, 7
- More stable repigmentation long-term 6
- Significantly fewer adverse effects (7.4% vs 57.2% with PUVA) 7
- Lower relapse rate at 12 months (12% vs 28% with PUVA) 1
- No systemic medication required 6, 7
Critical Patient Counseling Points
Before initiating treatment, patients must understand:
- NB-UVB does not alter the natural history of vitiligo 1
- Not all patients respond to treatment 1
- Hands and feet respond poorly regardless of treatment adherence 1
- Treatment limit exists due to potential photodamage risk 1
- Some patients (12%) may experience disease worsening despite treatment 1
- Maintenance of repigmentation requires long-term follow-up 1, 6
Common Pitfalls to Avoid
- Do not exceed 200 treatments for skin types I-III without careful risk-benefit discussion, as vitiliginous skin lacks melanin protection and is more susceptible to photodamage 1
- Do not continue treatment indefinitely without objective documentation of response using standardized photographs 2, 8
- Do not use NB-UVB as first-line therapy before attempting topical treatments in localized disease 1, 3
- Do not fail to check thyroid function before starting treatment due to high prevalence of autoimmune thyroid disease 3, 8
Special Populations
Pediatric patients: