Identifying gaps in the narrowband ultraviolet B phototherapy guidelines for vitiligo
Bhatia BK, Hamzavi IH. Identifying gaps in the narrowband ultraviolet B phototherapy guidelines for vitiligo. Pigment Cell and Melanoma Research 2017; 30(5):e131.
Pigment Cell and Melanoma Research
Phototherapy has been shown to be a safe, effective method of treatment for vitiligo. Although widely utilized, until recently, there were no consensus guidelines regarding protocol for phototherapy. An original article by Madigan et al. in 2016 and subsequent consensus article from the Vitiligo Working Group in 2017 have produced a protocol for phototherapy. This protocol covers frequency, initial dosing and subsequent modifications, how to define course of treatment, and assess response, among other points. This is a very large step in the direction of establishing a universal standard of care for phototherapy of vitiligo. Still, key gaps exist. At the forefront of these gaps is the lack of randomized controlled trials, as most recommendations are based upon expert consensus. In addition, as we move toward new systemic treatment options for vitiligo, including pulse‐dose steroids, minocycline, and JAK inhibitors, many questions arise. Questions that remain open for discussion include the role of phototherapy as an adjuvant to systemic treatment, the duration of treatment including active and maintenance therapy, and whether there is a need for adjustment of maximum or cumulative dose UV dose based upon skin type.