Key Takeaways
- Backbone therapy for generalized/nonsegmental vitiligo; best outcomes on face/neck, slower on acral sites.
- Typical schedule 2–3×/week for 24–48 sessions initial; earliest perifollicular islands by weeks 6–10.
- Combinations (tacrolimus/pimecrolimus, targeted excimer, JAK topicals for face) accelerate and deepen response.
- Safety profile favorable with gradual dose escalation; monitor erythema to avoid burns.
Protocols & Dosing
Table 1. Common NB-UVB frameworks.
| Parameter |
Typical setting |
Notes |
| Frequency |
2–3 sessions/week |
≥24–48 sessions initial |
| Start dose |
~70% MED or fixed 200–400 mJ/cm² |
Phototype/site adjust |
| Increment |
10–20% per visit |
Hold/reduce after >24 h erythema |
| Course length |
3–6 months |
Extend to 9–12 months if improving |
Efficacy by Anatomic Site
Table 2. Response gradient (typical cohorts).
| Site |
Response |
Notes |
| Face/neck |
High |
Early islands; best F-VASI change |
| Trunk/limbs (non-acral) |
Moderate |
Steady gains to 24–36 wks |
| Acral (hands/feet) |
Low–moderate |
Consider excimer add-on |
Time Course & Endpoints
- Track F-VASI/T-VASI, standardized photos, and Wood’s-lamp margins.
- Visible perifollicular islands: typically weeks 6–10; consolidation through week 24–36.
- Maintenance: taper frequency after plateau; prevent relapse on high-risk sites.
Safety
Table 3. Common adverse events.
| Event |
Pattern |
Mitigation |
| Erythema/tenderness |
Mild, dose-related |
Hold/reduce; emollients |
| Pruritus/dryness |
Occasional |
Emollients; spacing |
| Burn/blister (rare) |
Over-escalation |
Immediate rest; lower restart |
Home Phototherapy
- Consider for stable adherence after in-clinic titration; document dosing and safety checks.
- Educate on fixed distances, eye protection, and skip rules after erythema.
Outcome Tables (framework)
Table 4. Populate with cohort numerics.
| Outcome |
NB-UVB |
Comparator |
Interpretation |
| F-VASI % change (24–36 wks) |
— |
Observation/topicals |
Favours NB-UVB |
| F-VASI50/75 responders |
— |
— |
Higher with combinations |
| Acral response |
— |
— |
Improves with excimer add-on |
| Relapse at 6–12 mo |
— |
— |
Lower with maintenance |
Limitations
Heterogeneous dosing across cohorts; phototype/site mix influences outcomes; durability off-therapy varies; acral sites remain challenging.
References
- Cohort series evaluating NB-UVB 311 nm in generalized vitiligo with site-stratified outcomes.
- Comparative/adjunct studies with calcineurin inhibitors, excimer, and JAK topicals.
- Guidelines on NB-UVB dosing, safety, and home device protocols.