Impact On Quality Of Life And Clinical Efficacy Of Excimer Light In Vitiligo

Background:Vitiligo is a cutaneous depigmentation disorder characterized by well-demarcated white patches and it’s exact pathogenic mechanism is still unclear. Vitiliginous patches may influence patients’ psychological well-being and lead to negative impacts on quality of life. A variety therapeutic modalities have been proposed, including topical corticosteroids, topical immunomodulators, photo(chemo)therapy, and surgical therapy. However, none is uniformly effective and the treatment remains a challenge. Phototherapy with NB-UVB has been shown to be effective and safe in the management of the disease. Recently,308-nm excimer light has been introduced in the treatment modality with promising results. It is the latest NB-UVB therapy for the treatment of vitiligo which can induce repigmentation without global radiation exposure and now is one of the most popular targeted phototherapies.Objective:This study is made to evaluate the impact of vitiligo to the quality of life in Chinese patients as well as the clinical features of vitiligo that may influence the quality of life, to acknowledge if Chinese patients with vitiligo suffer from poor quality of life compared to other dermatological diseases; to determine the clinical efficacy and the treatment modality of 308-nm excimer light in treating vitiligo at different body sites in Chinese vitiligo patients as well as the potential side effects.Methods:The QOL were analysed with Skindex-29 scale in 55 vitiligo patients and 30 control (acne and keloid patients). The impact factors of QOL were analyzed by using multivariate analysis as well. This retrospective study analysed 47 segmental and non segmental vitiligo patients at different body sites. The patients were treated with excimer light once weekly or with the combination of He-Ne laser therapy. The photographs of the lesions which had been treated with excimer light for more than 8 treatment sessions were reviewed.Result:(1) The function and emotion scale of Skindex-29 in vitiligo group were higher than control (keloid & acne). However, It was not statistically significant different (P> 0.05). The symptoms scale in vitiligo group was significantly lower than, control (P< 0.05). The symptoms, emotion, function, and global score of QOL in female patients were significantly higher than those in male vitiligo patients (P< 0.05).(2) Skindex-29 score was correlated with gender and the disease activity of vitiligo. The emotion, function, and global score of female vitiligo patients were significantly higher than those in male vitiligo patients (P< 0.05). The function, emotion, and global score in patients with VIDA score of 0-2 were significantly higher than the patients with VIDA score of 3-4. (P< 0.05). However, there was no correlation to other clinical profiles, such as age, location, disease duration, disease severity, and family history.(3) Total 25/47 patients (53.2%) achieved more than 50% repigmentation (grade 3-4).15 of them achieved grade 4 repigmentation.18 patients (38.3%) achieved grade 1-2 repigmentation, while 4 (8.51%) patients didnt show any repigmentation (grade 0), with mean grade of repigmentation of 2.53. The onset of repigmentation was observed in the mean of 3.93 sessions. A total of 74.07%(20/27) lesions on the face, (54.54%) 6/11 lesions on the trunk,0%(0/11) lesions on the hand achieved more than 50% repigmentation. The treatment response showed anatomical preference, with the face/neck and trunk’s response rates were significant higher than hand (P< 0.05).(4) The average cumulative doses used in the face/neck, trunk, and hand were 3.69 ±2.16 J/cm2·5.01±2.34 J/cm2,13.99 ± 7.37 J/cm2, respectively. The average cumulative dose used in the face/neck and trunk were significantly lower than those in the hand (P< 0.05). Side effects were limited, mainly to symptomatic erythema.(5) The efficacy of different modalities of 308nm excimer light treatment such as once weekly excimer light monotherapy (group I); once weekly excimer light therapy with the combination of He-Ne laser (group II); and irregular excimer light monotherapy (group III) in face lesions were evaluated in present study. The results showed total of 90%(9/10) lesions,87.5%(7/8) lesions, and 37.5%(3/8) lesions on the face achieved> 50%repigmentation in the group I, II, and III, respectively. There is no significant difference in the treatment efficacy between once weekly excimer light monotherapy and once weekly excimer light with the combination of He-Ne laser (P>0.05). However, both treatment modalities are significantly better than irregular excimer light monotherapy (P<0.05).Conclusion:This study indicates that vitiligo impacts patient’s emotional, social life and interpersonal relationship with gender as an important factor that affects the QOL. QOL impairment in Chinese female patients with vitiligo was greater than that of male patients. Disease activity might also play a role in QOL of vitligo patients.This study also suggests that 308-excimer light is an effective and safe treatment modality for Chinese patients with vitiligo. However, the response might be different according to location of the lesions, with face/neck and trunk as the most responsive sites and hand as the least responsive site.