Home, targeted (non-laser) phototherapy for early vitiligo Dr Viktoria Eleftheriadou MD Centre of Evidence Based Dermatolo...
Background (1) <ul><li>Treatment - often unsatisfactory  </li></ul><ul><li>No cure BUT combination of topical/systemic age...
Background (2) <ul><li>Active/early onset vitiligo  lesions are  more responsive  to treatment with NB-UVB or combination ...
Current clinical practice for vitiligo <ul><li>BAD guidelines 2008 </li></ul><ul><li>First line: Topical steroids or tacro...
Level of evidence
<ul><li>Whole body units  vs. </li></ul><ul><li>Hand held  devices </li></ul>
Benefits of targeted phototherapy <ul><li>For early, focal disease ( including children)  </li></ul><ul><li>Unexposed skin...
“ Is home, targeted (non-laser) NB-UVB phototherapy combined with topical agents effective and safe for the treatment of e...
My preliminary work
HI-Light trial for vitiligo ( H ome  I ntervention   of  Light  therapy) <ul><li>Hypothesis: </li></ul><ul><li>assess the ...
Outcome measures for vitiligo  <ul><li>Percentage of repigmentation </li></ul><ul><li>Cessation of spreading </li></ul><ul...
Quality of life in vitiligo patients <ul><li>XXIst International Pigment Cell Conference (IPCC). Pigment Cell & Melanoma R...
Randomised, double blind controlled pilot trial
Thank you for your attention Acknowledgments to my colleagues: Dr K. Thomas Mrs M. Whitton Dr J. Batchelor Dr J. Ravenscro...
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Home, targeted (non-laser) phototherapy for early vitiligo .Dr Viktoria Eleftheriadou MD

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Home, targeted (non-laser) phototherapy for early vitiligo .Dr Viktoria Eleftheriadou MD
Treatment - often unsatisfactory
No cure BUT combination of topical/systemic agents and light therapy- most promising treatments
Whitton M, Pinart M, Batchelor et al. Interventions for vitiligo. Cochrane Database of Systematic Reviews 2010, Issue 1

Evidence for appropriate treatment in peadiatric patients is lacking
Active/early onset vitiligo lesions are more responsive to treatment with NB-UVB or combination of topical agents with NB-UVB

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This PPT is loaded as student material "as is", from the VRF Vitiligo Master Class Barcelona November 2011; VRF does not endorse or otherwise approve it.

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Home, targeted (non-laser) phototherapy for early vitiligo .Dr Viktoria Eleftheriadou MD

  1. 1. Home, targeted (non-laser) phototherapy for early vitiligo Dr Viktoria Eleftheriadou MD Centre of Evidence Based Dermatology University of Nottingham UK
  2. 2. Background (1) <ul><li>Treatment - often unsatisfactory </li></ul><ul><li>No cure BUT combination of topical/systemic agents and light therapy- most promising treatments </li></ul><ul><li>Whitton M, Pinart M, Batchelor et al. Interventions for vitiligo. Cochrane Database of Systematic Reviews 2010, Issue 1 </li></ul><ul><li>Evidence for appropriate treatment in peadiatric patients is lacking </li></ul><ul><li>Eleftheriadou V, Whitton ME, Gawkrodger DJ; et al, vitiligo priority setting partnership. Future research into the treatment of vitiligo: where should our priorities lie? Results of the vitiligo priority setting partnership. Br J Dermatol. 2011;164(3):530-536 </li></ul>
  3. 3. Background (2) <ul><li>Active/early onset vitiligo lesions are more responsive to treatment with NB-UVB or combination of topical agents with NB-UVB </li></ul><ul><li>References: </li></ul><ul><li>Lee, D.-Y., Kim, C.-R. and Lee, J.-H. (2010), Recent onset vitiligo on acral areas treated with phototherapy: need of early treatment. Photodermatology, Photoimmunology & Photomedicine, 26: 266–268. </li></ul><ul><li>2011), XXIst International Pigment Cell Conference (IPCC). Pigment Cell & Melanoma Research, 24: 742–863. </li></ul><ul><li>Active vitiligo lesions are more responsive to combination therapy with narrowband ultraviolet </li></ul><ul><li>light B and topical tacrolimus Y. Huang </li></ul><ul><li>Histopathological staging of vitiligo lesions – Implications for treatment. S. K. Attili, V. R. Attili </li></ul><ul><li>NHS Grampian, Dundee, UK </li></ul>
  4. 4. Current clinical practice for vitiligo <ul><li>BAD guidelines 2008 </li></ul><ul><li>First line: Topical steroids or tacrolimus </li></ul><ul><li>Second line: whole body NB-UVB </li></ul><ul><li>EDF guidelines 2012 (Vitiligo European Task Force) </li></ul><ul><li>First line: NB-UVB, combination of localised UVB+topical or systemic treatment </li></ul><ul><li>Second line: systemic treatments </li></ul><ul><li>Third line: surgical treatments </li></ul>
  5. 5. Level of evidence
  6. 6. <ul><li>Whole body units vs. </li></ul><ul><li>Hand held devices </li></ul>
  7. 7. Benefits of targeted phototherapy <ul><li>For early, focal disease ( including children) </li></ul><ul><li>Unexposed skin spared </li></ul><ul><li>Convenient, time-saving </li></ul><ul><li>Freely available on the market </li></ul>
  8. 8. “ Is home, targeted (non-laser) NB-UVB phototherapy combined with topical agents effective and safe for the treatment of early vitiligo in both children and adults compared to monotherapies alone (NB-UVB, topicals)? “ <ul><li>Large multi-centre double blind, randomised controlled trial </li></ul><ul><li>Effectiveness trial comparing localised NB-UVB combined with topical agents against NB-UVB alone and topicals alone </li></ul><ul><li>Assess if early lesions respond better </li></ul><ul><li>Suitable treatment for children? </li></ul><ul><li>Better compliance? Better QoL? </li></ul>
  9. 9. My preliminary work
  10. 10. HI-Light trial for vitiligo ( H ome I ntervention of Light therapy) <ul><li>Hypothesis: </li></ul><ul><li>assess the feasibility of conducting a multicentre RCT involving hand held NB-UVB devices for the treatment of focal/early vitiligo </li></ul><ul><li>Objectives: </li></ul><ul><li>Proportion of eligible patients, willingness to be randomised </li></ul><ul><li>Patients’ adherence & satisfaction </li></ul><ul><li>Educational package for patients </li></ul><ul><li>Outcome measures for the main RCT </li></ul>
  11. 11. Outcome measures for vitiligo <ul><li>Percentage of repigmentation </li></ul><ul><li>Cessation of spreading </li></ul><ul><li>Global improvement of the disease </li></ul><ul><li>Quality of life </li></ul><ul><li>Satisfaction with the treatment including cosmetically acceptability of the results </li></ul><ul><li>Patient benefit questionnaire </li></ul><ul><li>González U., Whitton M, Eleftheriadou V. et al Guidelines for Designing and Reporting Clinical Trials in Vitiligo . Arch Dermatol. Published online August 15, 2011. </li></ul><ul><li>Augustin M, Gajur AI, Reich C, Rustenbach SJ et al. Benefit evaluation in vitiligo treatment: development and validation of a patient-defined outcome questionnaire. Dermatology. 2008;217(2):101-6 </li></ul>
  12. 12. Quality of life in vitiligo patients <ul><li>XXIst International Pigment Cell Conference (IPCC). Pigment Cell & Melanoma Research2011, 24: 742–863. </li></ul><ul><li>Eleftheriadou V., Thomas K., Batchelor J et al. Systematic review of outcome measures for vitiligo </li></ul><ul><li>Eleftheriadou V. Thomas K., Whitton M. What outcomes are important to vitiligo patients and clinicians: survey results </li></ul>
  13. 13. Randomised, double blind controlled pilot trial
  14. 14. Thank you for your attention Acknowledgments to my colleagues: Dr K. Thomas Mrs M. Whitton Dr J. Batchelor Dr J. Ravenscroft Prof. H. Williams

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