RESULTS

The MED of lesional skin was between 200 and 500 mJ/cm2. In general repigmentation started 1-2 months after the beginning of the UV-B microphoto-therapy.
After 6 months of treatment 102 patients stopped the treatment after reaching the desired repigmentation, while 22 subjects stopped the therapy because of the insufficient results. The results after 12months were the following: 366 (69,3%) subjects responded with more than 75% repigmentation, 113 (21,4%) showed 50-75% repigmentation, 49 (9.3%) showed repigmentation in less then 50% of the area treated (vitiligo was aggravated in only 2 subjects of this group).
No adverse effects were noted. The compliance was excellent. No pain, nor burning or itching
sensations were reported by the subjects. The average cumulative UV-B dose with the treatment was 5.025 J/cm2 (range 2.4-6 J/cm2) per subject.
Until now we have examinated the 102 patients which have obtained a repigmentation >75% of the treated areas in the first year of treatment (two years ago): 99 subjects of this group have maintained the obtained results without any appreciable differences, only in 3 cases in fact vitiligo worsens.

DISCUSSION

According to the principles of evidence-based medicine, meta-analysis of all relevant studies in the literature recently showed that the highest mean success rates in repigmentation of vitiligo were achieved with narrow band UV-B, followed by broadband UV-B and oral methoxsalen plus UV-A therapy (2). The same study showed that oral methoxsalen plus UV-A was associated with the highest rates of side effects, while no side effects were reported with UV-B therapy (2).
Thus, following the recommendations of Njoo et al (2) based on the meta-analysis of the literature, it seems that when patients exhibit generalized vitiligo, UV-B (narrow band or broad band) therapy or, as a second choice, oral methoxsalen plus UVA, should be recommended. On the basis of the present study carried out with a novel device allowing limited and focused UV-B photoradiation, we suggest that UV-B therapy limited only to the vitiligo patches could be considered the firstchoice therapy for patients with vitiligo vulgaris, although more studies will be necessary to confirm the good results and establish the entity of possible long-term side effects. The protocol for the use of focused UV-B therapy here presented show that the therapy need not be continuous and that the cumulative UV-B doses received by the single patient with the BIOSKIN® device is obviously much lower than the cumulative UV-B dose received by the previously established UV-B treatment intended to treat the whole, or at least a considerable part, skin surface independent of the percentage of affected skin. It is implicit that therapy limited to  the vitiligo patches carries substantially less risk for skin cancer that any other kind of systemic
photoradiation, with or without oral intake of psoralen.
Finally it has been observed that only wellmotivated, highly compliant patients are suitable for photoradiation (2). A possible explanation is that this could depend not only on the exhausting photo(chemio) therapeutic algorithms, but also on the fact that systemic irradiation, even when successful, always provokes transient darkening of the non-affected skin, with a negative psychological impact related to the increased chromatic difference with the vitiligo patches.
Instead, as repigmentation obtained with the focused UV-B microphototherapy is limited to the treated vitiligo areas and the radiation is performed only once or twice per month, the novel phototherapy treatment is extremely well accepted by the vitiligo patients.

REFERENCES