Non Segmental Vitiligo in Children: Treatment with Narrow Band Ultraviolet B With and Without Topical 5 Fluorouracil on Ablated Lesions

Document Type : Original Article

Authors

1 Department of Dermatology, Faculty of Medicine, Minia university.

2 Department of Pediatric, Faculty of Medicine, Minia university.

3 Department of Clinical Pathology, Faculty of Medicine, Minia university

Abstract

Introduction: Vitiligo is a chronic idiopathic pigmentary disorder of the skin and hair, it is common 
in children below 12 years and its Management in children is difficult as therapeutic options are 
restricted when compared to that in adult patients. NB-UVB is an effective modality in the treatment 
of vitiligo with high success rates and low incidence of side effects and it is effective in childhood 
vitiligo. Skin ablation by mechanical dermabrasion with 5Fluorouracil (5FU) was introduced to treat 
vitiligo in 1983. This was modified replacing the mechanical dermabrasion by Erbium-YAG 
(ER:YAG) laser ablation and resulted in better prognosis in periungual vitiligo. The Aim of the 
study: Exploring the effect of the use of ER-YAG laser ablation plus application of topical 5FU on 
the outcome of short term NB-UVB phototherapy for children having non segmental vitiligo (NSV) 
and exploring safety of topical 5FU on this age group. Patients and Methods: The study was a left –
right comparative study that included 22 children with non-segmental vitiligo (NSV), attending the 
Dermatology Outpatient Clinic of Minia University Hospital. This study included 22 child with a total 
of 22-paired symmetrical non segmental vitiligo lesions in different body parts and their ages ranging 
from 8-12 year. The treated sides were divided in to 2 groups: Group (A): included the 22 right sides 
of the body in the children that will subjected to ER-YAG laser plus 5FU before simultaneous NBUVB therapy of both sides. Group (B) included the 22 left sides of the body in the same children that 
will subjected to NB-UVB phototherapy only. They were 9 (40.9%) females and 13 (59.1%) males 
with 22 paired vitiligo lesions in different body sites. Each pair was more or less symmetrical.They 
were collected during the period from March 2014 to April 2016. Results: The overall response to 
therapy was better using the combination therapy. (81.9%) of patients experienced a moderate to 
marked repigmentation response in the combination group compared with 0% of patients showed 
marked response and 13.6% showed moderate response in the mono-therapy group. In different body 
parts the response was significantly higher in lower limbs and feet but statistically insignificant in 
other body parts. Transient hyperpigmentation occurred in 3 cases and no koebnerization detected in 
any of the treated lesions. Conclusion: This study concluded that prior use of ER:YAG laser skin 
ablation, followed by 5FU application before NB-UVB phototherapy for non segmental vitiligo in 
children is a safe and tolerable technique that improves the outcome of short-term NB-UVB therapy 
and proved the safety of 5FU cream in this age group when applied to limited areas.
 

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