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UV-Bestrahlung zur Behandlung der Vitiligo (insbesondere UV-B-Schmalband 311 nm)

I             Studien (1 bis 5)

II            Hilfe zur Argumentation gegenüber Krankenkassen und Krankenversicherungen bei Problemen bei der Erstattung   der               Kosten der UV-Bestrahlungstherapie. (insbesondere auch der Heim-Bestrahlungstherapie). Für diese Hilfe gehen Sie bitte auf den Unterpunkt:  "Erstattung UV" (bitte Leiste links anklicken!)


I Studien zur UV-Bestrahlung bei Vitiligo (1 bis 5):
  
1. Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A.
Arch Dermatol 1997 Dec;133(12):1525-8    (ISSN: 0003-987X)
Westerhof W; Nieuweboer-Krobotova L
The Netherlands Institute for Pigmentary Disorders, Amsterdam, The Netherlands. snip-ww@knoware.nl.
OBJECTIVE: To compare the efficacy and safety of 2 treatment modalities, topical psoralen plus UV-A (PUVA) with unsubstituted psoralen and 311-nm UV-B radiation, in patients with vitiligo. DESIGN: This intervention study was designed as a before-and-after trial with 2 arms, in which patients were consecutively included. PATIENTS: Male (n = 99) and female (n = 182) patients, who predominantly had skin type III, with extensive, generalized vitiligo of more than 3 months' duration. INTERVENTIONS: Two patient groups were investigated. The first group of patients was treated for 4 months with either topical PUVA (n = 28) or 311-nm UV-B radiation (n = 78). The second group of patients, treated twice weekly with 311-nm UV-B radiation, was followed up for 3 (n = 60), 6 (n = 27), 9 (n = 37), or 12 months (n = 51). RESULTS: Thirteen (46%) patients in the first group treated with topical PUVA showed repigmentation after 4 months. Fifty-two patients (67%) in the 311-nm UV-B treatment group showed repigmentation after 4 months. After 3 months, 5 patients (8%) in the second group showed more than 75% repigmentation of lesional skin compared with 32 patients (63%) after 12 months. As in other treatment modalities, the face showed good repigmentation, whereas hands and feet responded poorly. No adverse effects were encountered with treatment with narrowband UV-B radiation, contrary to those seen with topical PUVA treatment. The cumulative UV-B dose was very small compared with that of the topical PUVA treatment. CONCLUSIONS: According to our results, the treatment of patients with vitiligo with 311-nm UV-B radiation is as efficient as with topical PUVA and has fewer adverse effects.

 
 
2. [Phototherapy with UV-B in vitiligo]
[Phototherapie mit UV-B bei Vitiligo.]
Z Hautkr 1990 Nov;65(11):1022-4, 1029    (ISSN: 0301-0481)
Koster W; Wiskemann A
Universitats-Hautklinik Hamburg.
We report on 14 patients suffering from extentise vitiligo, who underwent phototherapy with UVB. After 12 months of treatment, 8 (57.1%) of the patients showed repigmentation of more than 75%. Especially the patients with facial lesions of the skin types V and VI achieved a nearly complete and cosmetically very satisfying repigmentation.

  
3. Narrow-band UV-B micro-phototherapy: a new treatment for vitiligo.
J Eur Acad Dermatol Venereol 2003 Mar;17(2):171-7    (ISSN: 0926-9959)
Menchini G; Tsoureli-Nikita E; Hercogova J
Department of Dermosciences, University of Florence, Florence, Italy. g.menchini@dermatologia.it.
BACKGROUND: Vitiligo is a common, acquired, often familial, melanocytopenic disorder with focal depigmentation of the skin. There are several new treatments, that appear to have higher success rates than previous therapies for the treatment of vitiligo. Among these, the most promising one appears to be narrow-band UV-B therapy. OBJECTIVE: The aim of this open study is to evaluate the efficacy of the BIOSKIN micro-phototherapy in the treatment of vitiligo in 734 patients. SUBJECTS AND METHODS: Seven hundred and thirty-four individuals affected by vitiligo (segmental and non-segmental) were treated for 12 months with a new device called BIOSKIN that can produce a focused beam of narrow UV-B (microphoto-therapy) on vitiligo patches only. Photographs of the subjects were taken at the beginning of the therapy and every month thereafter for 12 months. The response to treatment was estimated in two comparable photographs using planimetry. The duration of the clinical study was of 2 years and 8 months. At the end of this period 734 patients had received each a mean of 24 sessions of treatment during a period of 12 months. RESULTS: Five hundred and ten subjects (69.48%) of the 734 achieved normal pigmentation on more than 75% of the treated areas. In particular, 112 of these were totally repigmented. One hundred and fifty-five (21.12%) individuals achieved 50-75% pigmentation of the treated areas, and 69 (9.40%) showed less than 50% repigmentation. No patients showed acute or chronic relevant adverse effects. CONCLUSION: BIOSKIN UV-B microphototherapy seems highly effective in restoring pigmentation in patients affected by vitiligo. As no side-effects have been observed, this could represent the treatment of choice for vitiligo limited to less than 30% of the skin surface.

 
4. UV-B radiation microphototherapy. An elective treatment for segmental vitiligo.
J Eur Acad Dermatol Venereol 1999 Sep;13(2):102-8    (ISSN: 0926-9959)
Lotti TM; Menchini G; Andreassi L
Department of Dermatology, University of Florence, Italy.
BACKGROUND: Vitiligo is a common disease of unknown cause that produces disfiguring white patches of depigmentation. Previous studies have suggested the effectiveness of UV-B radiation in generalized vitiligo (GV) therapy, but there was no evidence to support the same role for segmental vitiligo (SV). OBJECTIVE: The purpose of this study was to use UV-B radiation exclusively on vitiligo patches of individuals affected by SV to evaluate the effectiveness of this therapy. SUBJECTS AND METHODS: Eight individuals with SV were treated for 6 months with a new device called BIOSKIN that can produce a focused beam of UV-B (microphoto-therapy) on vitiligo patches only. Photographs of the subjects were taken at the beginning of the therapy and once a month thereafter for 6 months. The response to treatment was estimated in two comparable photographs using planimetry. A control group of eight individuals matched for sex and age was treated with placebo, using the same device but not releasing any kind of detectable light. RESULTS: After 6 months of microphototherapy five subjects of the eight studied achieved normal pigmentation on more than 75% of the treated areas. In particular, three of these were totally repigmented. Two individuals achieved 50-75% pigmentation of the treated areas, and only one showed less than 50% repigmentation. In the control group only one patient showed moderate repigmentation (less than 50%). CONCLUSION: UV-B microphototherapy seems highly effective in restoring pigmentation in patients affected by vitiligo. As no side-effects have been observed, this could represent the treatment of choice in the limited (segmental) forms of vitiligo.

 
5. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: the Vitiligo Area Scoring Index.
Arch Dermatol 2004 Jun;140(6):677-83    (ISSN: 0003-987X)
Hamzavi I; Jain H; McLean D; Shapiro J; Zeng H; Lui H
Division of Dermatology, Department of Medicine, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada.
BACKGROUND: There is currently no quantitative tool for evaluating vitiligo treatment response using parametric methods. OBJECTIVE: To develop and apply a simple clinical tool, the Vitiligo Area Scoring Index (VASI), to model the response of vitiligo to narrowband UV-B (NB-UV-B) phototherapy using parametric tests. DESIGN: Prospective, randomized, controlled, bilateral left-right comparison trial. SETTING: North American tertiary care, university-affiliated phototherapy center. PATIENTS: Patients older than 18 years with stable vitiligo involving at least 5% of their total body surface in a symmetric distribution. INTERVENTION: Treatment with NB-UV-B was given 3 times a week to half of the body on all patients for either 60 treatments or 6 months. The contralateral side served as a no-treatment control. MAIN OUTCOME MEASURE: Repigmentation was assessed using the VASI, which was based on a composite estimate of the overall area of vitiligo patches at baseline and the degree of macular repigmentation within these patches over time. The VASI was validated separately against physician and patient global assessments. The overall reductions in VASI for NB-UV-B and control groups were modeled by multilevel regression with random effects and compared parametrically. RESULTS: The VASI scoring correlated well with both patient and physician global assessments (P =.05 and P<.001, respectively, using ordinal logistic regression). The extent of repigmentation after 6 months on the treated side was 42.9% (95% confidence interval, 26.7%-59.0%) vs 3.3% (95% confidence interval -19.3% to 30.0%) on the untreated side (P<.001). A significant difference between control and NB-UV-B groups was apparent within the first 2 months of therapy. The legs, trunk, and arms were much more likely to repigment than the feet and hands. CONCLUSIONS: The VASI is a quantitative clinical tool that can be used to evaluate vitiligo parametrically. Patients treated with NB-UV-B can be expected to achieve approximately 42.9% repigmentation of their vitiligo after 6 months of treatment, with the greatest response being achieved over the trunk and nonacral portions of the extremities.

II            Zur Hilfe zur Argumentation gegenüber Krankenkassen und Krankenversicherungen bei Problemen bei der Erstattung   der               Kosten der UV-Bestrahlungstherapie. (insbesondere auch der Heim-Bestrahlungstherapie) klicken sie bitte auf den Button in der Leiste links!