home, targeted (non-laser) phototherapy for early vitiligo .dr viktoria eleftheriadou md

SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease

Home, targeted (non-laser) phototherapy for early vitiligo

Dr Viktoria Eleftheriadou MDCentre of Evidence Based DermatologyUniversity of NottinghamUK


Background (1) Treatment - often unsatisfactory No cure BUT combination of topical/systemic agents and

light therapy- most promising treatmentsWhitton 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

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


Background (2) Active/early onset vitiligo lesions are more

responsive to treatment with NB-UVB or combination of topical agents with NB-UVB

References: 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. 2011), XXIst International Pigment Cell Conference (IPCC). Pigment Cell & Melanoma Research, 24: 742–863.o Active vitiligo lesions are more responsive to combination therapy with narrowband ultravioletlight B and topical tacrolimus Y. Huango Histopathological staging of vitiligo lesions – Implications for treatment. S. K. Attili, V. R. AttiliNHS Grampian, Dundee, UK


Current clinical practice for vitiligo

BAD guidelines 2008First line: Topical steroids or tacrolimusSecond line: whole body NB-UVB

EDF guidelines 2012 (Vitiligo European Task Force)First line: NB-UVB, combination of localised UVB+topical or systemic treatment Second line: systemic treatmentsThird line: surgical treatments


Level of evidence


Whole body units vs. Hand held devices


Benefits of targeted phototherapy For early, focal disease (including

children) Unexposed skin spared Convenient, time-saving

Freely available on the market


“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)? “ Large multi-centre double blind, randomised controlled trial Effectiveness trial comparing localised NB-UVB combined with topical

agents against NB-UVB alone and topicals alone Assess if early lesions respond better Suitable treatment for children? Better compliance? Better QoL?


My preliminary work


HI-Light trial for vitiligo(Home Intervention of Light therapy)

Hypothesis: assess the feasibility of conducting a multicentre RCT involving hand held NB-UVB devices for the treatment of focal/early vitiligo

Objectives:Proportion of eligible patients, willingness to be randomisedPatients’ adherence & satisfactionEducational package for patients Outcome measures for the main RCT


Outcome measures for vitiligo Percentage of repigmentation Cessation of spreading Global improvement of the disease Quality of life Satisfaction with the treatment including cosmetically

acceptability of the results Patient benefit questionnaire

González U., Whitton M, Eleftheriadou V. et al Guidelines for Designing and Reporting Clinical Trials in Vitiligo. Arch Dermatol. Published online August 15, 2011.

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


Quality of life in vitiligo patients

XXIst International Pigment Cell Conference (IPCC). Pigment Cell & Melanoma Research2011, 24: 742–863.Eleftheriadou V., Thomas K., Batchelor J et al. Systematic review of outcome measures for vitiligoEleftheriadou V. Thomas K., Whitton M. What outcomes are important to vitiligo patients and clinicians: survey results


Randomised, double blind controlled pilot trial


Thank you for your attentionAcknowledgments to my colleagues:Dr K. ThomasMrs M. WhittonDr J. BatchelorDr J. Ravenscroft Prof. H. Williams

home, targeted (non-laser) phototherapy for early vitiligo .dr viktoria eleftheriadou md

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