Key Takeaways
- NB-UVB (311–313 nm) consistently induces clinically meaningful repigmentation across multiple cohorts; face responds best, acral sites worst.
- Typical regimens are 2–3 sessions/week with stepwise dose escalation; early visible response predicts stronger endpoints.
- Large population data suggest no increase in melanoma or non-melanoma skin cancer risk with long-term NB-UVB in vitiligo; actinic keratoses may rise after very high session counts.
- Compared with PUVA, NB-UVB offers similar or better effectiveness with fewer adverse effects and simpler logistics.
Abstract
This scholarly review synthesizes outcomes from key NB-UVB (311 nm) cohorts in vitiligo, summarizes practical dosing protocols, highlights predictors of response (anatomic site, early improvement, phototype), and reviews long-term safety including comparative data versus PUVA.
Cohorts & Outcomes
| Study | Design / n | Regimen | Primary outcomes | Notes |
|---|---|---|---|---|
| Scherschun et al., 2001 (JAAD) | Retrospective; n=7 | 3×/wk; start 280 mJ/cm²; +15% each session | 5/7 achieved >75% repigmentation (mean 19 treatments); others 50% and 40% after 46–48 treatments | Mild erythema/pruritus; rapid facial response |
| Nicolaidou et al., 2007 (JAAD) | Prospective; n=70 | 2×/wk | ≥75% repigmentation: face 34.4%; body 7.4%; 14.3% maintained stability 4 years post-therapy | Darker phototypes and early responders fared better |
| Kanwar et al., 2005 (Clin Exp Dermatol) | Pediatric; n=26 (20 completed) | 3×/wk up to 1 year | Marked–complete repigmentation in 15/20 (75%); moderate 20%; mild 5% | Safe and effective in children |
| Hamzavi et al., 2004 (JAAD) | Parametric VASI model | NB-UVB course | Expected mean ≈42.9% repigmentation at 6 months; trunk & non-acral areas respond best | Supports use of VASI for quantitative tracking |
| Westerhof & Nieuweboer-Krobotova, 1997 (Arch Dermatol) | Comparative vs topical PUVA | 311 nm UV-B vs PUVA | NB-UVB efficacy comparable to PUVA with fewer adverse effects | Helped establish NB-UVB as first-line option |
Dosing Protocols
- Frequency: 2–3 sessions/week; avoid back-to-back days for sensitive sites.
- Escalation: Start around 200–300 mJ/cm² (clinic-specific) and increase 10–20% per session aiming for mild, short-lived erythema.
- Adjustments: Hold/escalation pauses for symptomatic burns; reduce dose for face/intertriginous areas; gradual re-titration after missed weeks.
- Monitoring: Standardized photos; VASI/F-VASI to quantify change; reassess at ~12–16 weeks for early response.
Predictors of Response
- Anatomic site: Face > trunk/non-acral > distal acral areas.
- Early improvement: Visible repigmentation in the first month correlates with stronger endpoints.
- Phototype: III–V may achieve higher rates of cosmetically acceptable repigmentation on the face.
Safety & Long-Term Data
Population-scale analyses in vitiligo report no increase in melanoma or non-melanoma skin cancer with NB-UVB, even at high cumulative sessions; actinic keratoses may rise after very high exposures. Compared with PUVA, NB-UVB avoids psoralen side effects and complex shielding/logistics.
Limitations
Heterogeneity in dosing schedules, definitions of response, and follow-up complicates cross-study comparisons; acral disease remains refractory and may require adjuncts or surgical approaches.
References
- Westerhof W, Nieuweboer-Krobotova L. Treatment of vitiligo with UV-B vs topical PUVA. Arch Dermatol. 1997.
- Scherschun L, Kim JJ, Lim HW. Narrow-band UVB is a useful and well-tolerated treatment for vitiligo. J Am Acad Dermatol. 2001.
- Hamzavi I, et al. Parametric modeling of NB-UVB using VASI in vitiligo. J Am Acad Dermatol. 2004.
- Kanwar AJ, Dogra S. Narrow-band UVB for generalized vitiligo in children. Clin Exp Dermatol. 2005.
- Nicolaidou E, et al. Efficacy, predictors, and long-term follow-up with NB-UVB. J Am Acad Dermatol. 2007.
- Bae JM, et al. Skin cancer/precancer risk in vitiligo with NB-UVB. JAMA Dermatol. 2020.
- Harris JE, Scharf M. Vitiligo nbUVB Treatment Protocol (guideline PDF).
- Khanna U. What is new in NB-UVB therapy for vitiligo? Review.