Is Narrowband UVB Phototherapy in Combination With Nonsteroidal Topical Medications More Effective at Repigmentation of Vitiligo Lesions When Compared to Narrowband UVB Therapy Alone in Healthy Men and Women Between the Ages of 11 and 69?
Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
John Cavenagh, MBA, PhD, PA-C
OBJECTIVE: The objective of this selective EBM review is to determine whether or not narrowband UVB (NB-UVB) phototherapy in combination with nonsteroidal topical medications is more effective at repigmentation of vitiligo lesions when compared to NB-UVB therapy alone in healthy men and women between the ages of 11 and 69.
STUDY DESIGN: Review of three peer-reviewed randomized controlled trials written in English, two of which were published in 2014, and one in 2011.
DATA SOURCES: Studies were selected based on the method of study, the randomized- control structure of the studies, and the relevance to the clinical question, and all were identified as patient-oriented evidence that matters (POEMS).
OUTCOMES MEASURED: A variety of methods were used to evaluate the outcomes of treatment, including visual analog scale (VAS), Patient Global Assessment (PGA), Investigator Global Assessment (IGA), VisitrakTM, palm thumb method, vitiligo scoring index (VASI), and the Lund and Browder (L & B) index.
RESULTS: Three different nonsteroidal topicals were used in conjunction with NB-UVB, calcipotriol, tetracycline, and 0.1% tacrolimus ointment. Of these three topicals, only 0.1% tacrolimus ointment in combination with NB-UVB was shown to have a significant result, with a 13.1% reduction in lesions and a P value of 0.005, indicating a difference when compared to NB-UVB therapy alone. The P values for the other two studies were very similar, with values of 0.557, and 0.566, suggesting they have no enhancing effect when used with NB-UVB.
CONCLUSION: Two of the three studies analyzed concluded that the addition of a nonsteroidal ointment to NB-UVB was not more effective than NB-UVB alone. The only topical that had statistical support was 0.1% tacrolimus ointment, an immunosuppressive agent, suggesting that this topical enhances treatment outcome when used with NB-UVB. NB-UVB is a gold standard of care for the treatment of generalized vitiligo. Immunosuppressive agents, such as tacrolimus, when added benefit patients by decreasing a larger area of depigmentation. Further research is warranted to obtain a better understanding of the role of nonsteroidal immunosuppressive ointments in vitiligo treatment.
Baier, Cassandra, "Is Narrowband UVB Phototherapy in Combination With Nonsteroidal Topical Medications More Effective at Repigmentation of Vitiligo Lesions When Compared to Narrowband UVB Therapy Alone in Healthy Men and Women Between the Ages of 11 and 69?" (2016). PCOM Physician Assistant Studies Student Scholarship. 260.