For adults and children with vitiligo, the combination of narrowband ultraviolet B (NB-UVB) and topical corticosteroid (TCS) is superior to TCS alone, but treatment success is only 27 percent with the combination, according to a study published in the May issue of the British Journal of Dermatology.

Kim S. Thomas, Ph.D., from the Centre of Evidence Based Dermatology at the University of Nottingham in the United Kingdom, and colleagues examined the effectiveness of handheld NB-UVB and a combination of potent TCS and NB-UVB compared with TCS alone in adults and children with vitiligo. A total of 517 patients were randomly assigned to TCS, NB-UVB, and combination (173, 169, and 175, respectively). The primary outcome was treatment success at a target patch, assessed at nine months.

The researchers found that the proportion of participants with target patch treatment success was 17, 22, and 27 percent for TCS, NB-UVB, and combination, respectively. Combination treatment was superior to TCS, with an adjusted between-group difference of 10.9 percent (95 percent confidence interval, 1.0 to 20.9 percent; P = 0.032), while NB-UVB was not superior (between-group difference, 5.2 percent; 95 percent confidence interval, −4.4 to 14.9 percent; P = 0.29). The likelihood of achieving treatment success was increased for participants using interventions with ≥75 percent expected adherence; the effects were lost when treatment was stopped.

"For people with vitiligo requiring second-line therapy, combination treatment with potent TCS and NB-UVB may be helpful," the authors write. "Patients should be informed that only about one-quarter of those seeking treatment are likely to achieve a substantial treatment response, that considerable time commitment is required, and that response is likely to be slow."

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