Phototherapy is a mainstay of
vitiligo treatment and has varying rates of efficacy. Narrowband ultraviolet (UV) B (NB-UVB) and UVA have been used for decades, but it is only recently that monochromatic excimer light (MEL) was developed for use in dermatology and adapted for the treatment of
vitiligo. The specific 308-nm radiation wavelength is delivered in a targeted form by the
xenon-chloride excimer laser and is also available in an incoherent form that is commonly referred to as the excimer lamp. MEL administered by both
laser and lamp has shown efficacy superior to NB-UVB for the treatment of
vitiligo and induces more changes at the cellular level than conventional UVB modalities. The
excimer laser is effective in adults and children with
vitiligo in all skin types as monotherapy or in combination with other established
vitiligo therapeutics. Treatment regimens studied included
excimer laser two to three times weekly for up to 36 weeks. Patients commonly achieved > 75% repigmentation. The
laser has also been used in combination with topical
corticosteroids,
calcineurin inhibitors and
vitamin D analogues, as well as surgery, thus further expanding treatment options for patients with
vitiligo. The excimer lamp has been used for treatments one to three times a week for up to 24 weeks and was found to be equal to
excimer laser in a head-to-head comparison. It has also been used in combination with topical
corticosteroids and oral
vitamin E. Both MEL modalities have a limited adverse side-effect profile. Long-term effects are yet to be determined; however, based on available data on UVB
phototherapy as well as the properties of MEL devices, there is probably only a minimal increased
malignancy risk.