India: In a groundbreaking development in acral vitiligo treatment, a split-body randomized controlled trial has demonstrated the efficacy of whole-body and targeted narrowband ultraviolet B (NB-UVB) phototherapy. The trial, conducted by a team of dermatologists, reveals promising results in stabilizing acral vitiligo with minimal repigmentation beyond the wrists and ankles.

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Both whole-body and targeted NB-UVB are effective treatment options for patients with acral vitiligo; however, the feet and hands are more resistant to treatment, the study stated.

"At the end of the treatment, over 50% repigmentation was achieved in 42.2% of the limbs in the whole-body phototherapy group and 37.5% of the limbs in the targeted phototherapy group. There was no repigmentation in any of the lesions distal to the ankle and wrist in both groups," the researchers reported.
Vitiligo, a chronic skin condition characterized by depigmentation, affects millions worldwide, causing significant psychological and emotional distress for those afflicted. Acral vitiligo, specifically involving the extremities such as hands and feet, presents unique challenges due to its resistance to traditional treatments.
In vitiligo, narrowband ultraviolet B phototherapy promotes stability and repigmentation. No studies have compared targeted NB-UVB with whole-body NB-UVB treating acral vitiligo. Therefore, Keshavamurthy Vinay, Post Graduate Institute of Medical Education and Research, Chandigarh, India, and colleagues aimed to compare whole-body NB-UVB with targeted NB-UVB in inducing stability and repigmentation in acral vitiligo.
For this purpose, the researchers recruited thirty-two patients with bilaterally symmetrical acral vitiligo lesions (distal to elbows and knees). Patients received whole-body NB-UVB treatment, with one foot and one hand shielded until knee and elbow followed by targeted NB-UVB treatment on the shielded side.
Patients were assessed at intervals of 4 weeks for 24 weeks using Vitiligo Skin Activity Score (VSAS), Vitiligo Disease Activity (VIDA) score, Vitiligo Area Scoring Index (determined through fingertip method, using the method for calculating facial-VASI), and degree of repigmentation.
The researchers reported the following findings:
After 12 weeks, 87.5% of patients achieved a VIDA score of 3, with none having active disease at 24 weeks.
Over 50% repigmentation was observed in 42.2% and 37.5% of limbs in whole-body and targeted groups, respectively.
No improvement in F-VASI scores of hands and feet (distal to wrist and ankles) was noted with either modality over the 24 weeks.
In conclusion, the study showed comparable repigmentation rates between whole-body and targeted narrowband ultraviolet B groups. The limited effectiveness of phototherapy in the repigmentation of feet and hands underscores an important therapeutic gap.
Reference:
Thind, A., Vinay, K., Mehta, H., Bishnoi, A., Kumaran, M. S., & Parsad, D. (2024). Whole-body and targeted narrowband ultraviolet B phototherapy effectively stabilize acral vitiligo with negligible repigmentation beyond wrists and ankles: Results from a split-body randomized controlled trial. Photodermatology, Photoimmunology & Photomedicine, 40(2), e12960. https://doi.org/10.1111/phpp.12960