目的:探讨局部CO2激光-UVB方案之前的UVB光疗对耐药非节段白癜风患者的短期和长期影响。
方法:这种单中心,prospective,分割面/身体,评估者盲法研究包括常规治疗难以治疗的稳定性白癜风成年患者。选择两个对称病变。光疗是一侧覆盖的,直到最小的红斑。3天内,双方进行了为期31个月的激光训练。每次激光会议后,光疗每周恢复三次,所有的病变都被发现了,直到最后一次激光疗程后8周。在基线,在治疗结束时,5年后,记录医师平均改善评分(MISP)和患者满意度10分视觉模拟评分(VAS).
结果:纳入10例患者(8名女性和2名男性);他们的平均年龄为32.9岁;以光型III为主;白癜风的平均病程为3年。在治疗结束和5年后,用UVB-CO2-UVB治疗的病变评分(平均MISP3.0和2.9,平均ΔVAS分别为4.5和3.9),高于仅用CO2-UVB治疗的病变(平均MISP2.5和2.4,平均ΔVAS4.1和3.6)。五年后,一名患者失去部分反应,两名患者两侧出现轻度色素沉着。
结论:在CO2-UVB之前暴露于UVB解释了更高的分数,因为它是两侧之间的唯一变量。它可以改善抗性病变的反应,并在5年内持续不断的结果。
OBJECTIVE: To explore the short- and long-term effects of UVB phototherapy preceding a fractional CO2 laser-UVB protocol in patients with resistant nonsegmental vitiligo.
METHODS: This single-center, prospective, split-face/body, evaluator-blinded study included adult patients with stable vitiligo refractory to conventional treatments. Two symmetrical lesions were selected. Phototherapy was delivered with one side covered, until minimal erythema. Within 3 days, 31-month-apart sessions of laser were performed on both sides. After each laser session, phototherapy was resumed three times weekly, with all lesions uncovered, until 8 weeks after the last laser session. At baseline, at the end of treatment, and 5 years later, a Mean Improvement Score by Physician (MISP) and a patient satisfaction 10-point visual analog score (VAS) were recorded.
RESULTS: Ten patients (8 women and 2 men) were included; their mean age was 32.9 years; phototype III was predominant; the mean duration of vitiligo was 3 years. At the end of treatment and 5 years later, scores of lesions treated with UVB-CO2 -UVB (mean MISP 3.0 and 2.9, mean ΔVAS 4.5 and 3.9, respectively), were higher than those of lesions treated only with CO2 -UVB (mean MISP 2.5 and 2.4, mean ΔVAS 4.1 and 3.6, respectively). After 5 years, one patient lost his partial response and two patients developed light hyperpigmentation on both sides.
CONCLUSIONS: Exposure to UVB before CO2 -UVB explains the higher scores as it was the only variable between the two sides. It may improve the response of resistant lesions with a constantly sustained result over 5 years.