UV Types for Aesthetic Skin Pigmentation Improvement
For aesthetic improvement of skin pigmentation disorders like vitiligo, narrowband UVB (NB-UVB, specifically 311-313 nm) is the primary recommendation, with PUVA (broadband UVA 315-400 nm combined with psoralen) as an alternative option, both achieving significant repigmentation rates. 1
Primary UV Modalities for Pigmentation Enhancement
Narrowband UVB (NB-UVB)
- NB-UVB at 311-313 nm wavelength demonstrates superior efficacy for vitiligo repigmentation, with 92% of patients achieving up to 100% repigmentation when treated three times weekly 1
- In pediatric vitiligo patients treated twice weekly for up to one year, 53% achieved >75% repigmentation with 80% showing disease stabilization 1
- Facial and small areas of vitiligo respond more favorably than larger areas or acral sites 1
- The mechanism works through increased melanin production and potential immunomodulation 1
- NB-UVB uses Philips TL-01 lamps (peak 311 nm) or Arimed 311 lamps (peak 313 nm) 1
PUVA (Psoralen + UVA)
- PUVA combines psoralen photosensitization with broadband UVA (315-400 nm, peak 350 nm) and shows equivalent efficacy to NB-UVB for vitiligo 1
- Achieves similar repigmentation patterns as NB-UVB, with facial areas responding better than acral sites 1
- Uses broadband UVA lamps emitting across the entire UVA spectrum 1
UVA1 Phototherapy
- Long-wave UVA1 (340-400 nm) penetrates more deeply than UVB or standard UVA and has shown clinical efficacy in small case series 1
- Uses fluorescent lamps with emission between 350-400 nm, peaking around 370 nm 1
- Medium-pressure metal halide lamps can deliver high irradiances (90-130 mW/cm²) for UVA1 therapy 1
Critical Safety Considerations
Skin Type-Specific Dosing
- Starting doses must be individualized based on Fitzpatrick skin type, with Type I requiring the lowest initial doses (130 mJ/cm² for NB-UVB, 0.5 J/cm² for PUVA) and Type VI requiring the highest (400 mJ/cm² for NB-UVB, 3.0 J/cm² for PUVA) 2
- Darker skin types (III-VI) experience delayed tanning responses and specific pigmentary complications including nail changes and mottled hypo/hyperpigmentation requiring monitoring 2
Long-Term Cancer Risks
- High cumulative PUVA exposure increases squamous cell carcinoma risk 14-fold compared to low-dose PUVA, with 26% of patients on continuous maintenance developing non-melanoma skin cancer 2
- Melanoma risk increases after 15 years of PUVA exposure or with high cumulative doses 2
- Cumulative lifetime PUVA exposure should be limited to 1200 J/cm² and/or 250 sessions 1
- NB-UVB shows no significant association with skin cancer at median 5.5 years follow-up 2
- Male patients require genital shields during all PUVA treatments due to elevated squamous cell carcinoma risk 2
Treatment Protocols
- Treatments should be spaced at least 48-72 hours apart to allow assessment of photoreactions from previous treatment 2
- NB-UVB standard protocol is three times per week on nonconsecutive days 2
- PUVA is typically administered twice weekly for 12-14 weeks 1
- All patients must wear UV-protective goggles during treatments 2
Comparative Effectiveness
NB-UVB and PUVA show equivalent efficacy for vitiligo repigmentation in controlled trials, with no significant difference in time to relapse 1. However, NB-UVB carries substantially lower long-term cancer risk, making it the preferred first-line option for most patients 2. PUVA may be reserved for cases where NB-UVB fails or for patients requiring deeper tissue penetration 1.
Common Pitfalls to Avoid
- Do not use broadband UVB (280-360 nm) as it is more erythemogenic than NB-UVB and has declined in use 1
- Avoid maintenance PUVA therapy as risks outweigh benefits for most patients who achieve excellent clinical responses 1
- Never combine PUVA with ciclosporin as this significantly accelerates skin cancer development 1
- Ensure correct lamp installation—mislabeling can result in wrong UV spectrum exposure with serious clinical consequences 1