Abstract
The effect of PUVA (psoralen plus UVA)-treatment of vitiligo with oral trimethylpsoralen (TMP) plus black light or sunlight was compared with oral or topical 8-methoxypsoralen (8-MOP) plus black light or sunlight.
Sixty-eight patients with vitiligo were treated with PUVA over three months or longer. Out of the 26 patients with oral TMP and black light, six showed 75-100% repigmentation and eleven 25-75% repigmentation. Considerable repigmentation in these cases were without severe sunburn. Out of 15 patients treated with oral 8-MOP and black light, three showed 75-100% repigmentation and seven 25-75% repigmentation. In the treatment with TMP plus black light, repigmentation appeared a little later than 8-MOP plus black light, but when the former was continued for longer periods, the results were better than the latter. Black light was as effective as sunlight, except that the latter showed a slightly better result in the 8-MOP group. However, black light is generally recommended, because the irradiation dose can be easily controlled, it can be easily applied on the unexposed areas and can used by the patient at home. In the treatment with topical 8-MOP plus black light, both excellent and ineffective results were obtained in high percentage. As topical 8-MOP often causes severe sunburn, the irradiation should be carefully controlled.
No side effects were observed in the 37 patients treated with oral TMP, while four of the 22 patients with oral 8-MOP complained of nausea and anorexia. Besides, a severe sunburn was observed in one of the nine patients with 8-MOP. Liver function tests per bimonthly were within normal limits in all patients.
In conclusion, oral TMP plus black light is recommended for the treatment of vitiligo. The mechanism of melanogenesis with psoralen was also discussed.
