Home, targeted (non-laser) phototherapy for early vitiligo .Dr Viktoria Eleftheriadou MD
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Transcript of 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
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
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
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
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
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
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
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
Level of evidence
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
Whole body units vs. Hand held devices
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
Benefits of targeted phototherapy For early, focal disease (including
children) Unexposed skin spared Convenient, time-saving
Freely available on the market
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
“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?
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
My preliminary work
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
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
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
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
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
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
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
Randomised, double blind controlled pilot trial
SPRUSDSetting Priorities & Reducing Uncertainties for People with Skin Disease
Thank you for your attentionAcknowledgments to my colleagues:Dr K. ThomasMrs M. WhittonDr J. BatchelorDr J. Ravenscroft Prof. H. Williams