Fototerapia y otras alternativas terapéuticas para el manejo del vitiligo, diez años de experiencia en el Servicio de Fototerapia del Centro Dermatológico de la Universidad CES
Palabras clave:
vitiligo, tratamiento, fototerapiaResumen
El vitiligo es un trastorno adquirido del pigmento de etiología desconocida, que se caracteriza clínicamente por máculas acrómicas de distribución variable, secundarias a la pérdida de melanocitos funcionales en la epidermis. Existen múltiples opciones de tratamiento, con el fin de lograr la mejor respuesta clínica con mínimos efectos secundarios. En la actualidad, los estudios han demostrado que la fototerapia con radiación ultravioleta de tipo B de banda estrecha es el tratamiento de elección en pacientes con vitiligo moderado a grave. En esta revisión abordaremos las diferentes opciones terapéuticas para el vitiligo basados en la información disponible, haciendo énfasis en el uso de la fototerapia.
Biografía del autor/a
Natalia Vélez
Médica residente, Programa de Dermatología, Universidad CES, Medellín, Colombia
Tatiana González
Médica residente, Programa de Dermatología, Universidad CES, Medellín, Colombia
Liliana Bohórquez
Médica residente, Programa de Dermatología, Universidad CES, Medellín, Colombia
Ana Milena Montes
Médica residente, Programa de Dermatología, Universidad Pontificia Bolivariana, Medellín, Colombia.
Claudia Andrea Hernández
Médica residente, Programa de Dermatología, Universidad Pontificia Bolivariana, Medellín, Colombia.
Sol Beatriz Jiménez
Coordinadora de investigación, Programa de Dermatología, Universidad CES, Medellín, Colombia
Referencias bibliográficas
1. Halder RM, Taliaferro SJ. Vitiligo. En: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick's Dermatology in General Medicine. Seventh edition. New York: McGraw Hill; 2008. p. 616-22.
2. Spritz RA, Gowan K, Bennett DC, Fain PR. Novel vitiligo susceptibility loci on chromosomes 7 (AIS2) and 8 (AIS3), confirmation of SLEV1 on chromosome 17, and their roles in an autoimmune diathesis. Am J Hum Genet. 2004;74:188-91.
3. Lotti T, Gori A, Zanieri F, Colucci R, Moretti S. Vitiligo: new and emerging treatments. Dermatol Ther. 2008;21:110-7.
4. Le Poole IC, Luiten RM. Autoimmune etiology of generalized vitiligo. Curr Dir Autoimmun. 2008;10:227-43.
5. Taïeb A, Picardo M. Vitiligo. N Engl J Med 2009;8;360:160-9.
6. Taïeb A, Picardo M. The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. Pigment Cell Res. 2007;20:27-35.
7. Bhatnagar A, Kanwar AJ, Parsad D, De D. Psoralen and ultraviolet A and narrow-band ultraviolet B in inducing stability in vitiligo, assessed by vitiligo disease activity score: an open prospective comparative study. J Eur Acad Dermatol Venereol. 2007;21:1381-5.
8. Njoo MD, Das PK, Bos JD, Westerhof W. Association of the Köbner phenomenon with disease activity and therapeutic responsiveness in vitiligo vulgaris. Arch Dermatol. 1999;135:407-13 .
9. Forschner T, Buchholtz S, Stockfleth E. Current state of vitiligo therapy – evidence-based analysis of the literature. J Dtsch Dermatol Ges. 2007;5:467-75.
10. Kostovic K, Pasic A. New treatment modalities for vitiligo: focus on topical immunomodulators. Drugs. 2005;65:447-59.
11. Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Whitton ME, Watts MJ, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008;159:1051-76.
12. Hamzavi I, Jain H, McLean D, Shapiro J, Zeng H, Lui H. Parametric modelling of narrow band UV-B phototherapy for vitiligo using a novel quantitative tool. Arch Dermatol. 2004;140:677-83.
13. Brazzelli V, Antoninetti M, Palazzini S, Barbagallo T, De Silvestri A, Borroni G. Critical evaluation of the variants influencing the clinical response of vitiligo: study of 60 cases treated with ultraviolet B narrowband phototherapy. J Eur Acad Dermatol Venereol. 2007;21:1369-74.
14. Njoo MD, Westerhof W. Vitiligo. Pathogenesis and treatment. Am J Clin Dermatol. 2001;2:167-81.
15. Fai D, Cassano N, Vena GA. Narrow-band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients. J Eur Acad Dermatol Venereol. 2007;21:916-20.
16. Firooz A, Bouzari N, Fallah N, Ghazisaidi B, Firoozabadi MR, Dowlati Y. What patients with vitiligo believe about their condition. Int J Dermatol. 2004;43:811-4.
17. Kist JM, van Voorhees AS. Narrowband ultraviolet B therapy for psoriasis and other skin disorders. Adv Dermatol. 2005;21:235-50.
18. Mason CP, Gawkrodger DJ. Vitiligo presentation in adults. Clin Exp Dermatol. 2005;30:344-5.
19. Sitek JC, Loeb M, Ronnevig JR. Narrowband UVB therapy for vitiligo: does the repigmentation last? J Eur Acad Dermatol Venereol. 2007;21:891-6.
20. Parsad D, Kanwar AJ, Kumar B. Psoralen-ultraviolet A vs. narrow-band ultraviolet B phototherapy for the treatment of vitiligo. J Eur Acad Dermatol Venereol. 2006;20:175-7.
21. Kanwar AJ, Dogra S, Parsad D, Kumar B. Narrow-band UVB for the treatment of vitiligo: an emerging effective and welltolerated therapy. Int J Dermatol. 2005;44:57-60.
22. Dogra S, Parsad D. Combination of narrowband UV-B and topical calcipotriene in vitiligo. Arch Dermatol. 2003;139:393.
23. Hercogová J, Buggiani G, Prignano F, Lotti T. A rational approach to the treatment of vitiligo and other hypomelanoses. Dermatol Clin. 2007;25:383-92.
24. Koca R, Armutcu F, Altinyazar HC, Gürel A. Oxidant-antioxidant enzymes and lipid peroxidation in generalized vitiligo. Clin Exp Dermatol. 2004;29:406-9.
25. Nicolaidou E, Antoniou C, Stratigos AJ, Stefanaki C, Katsambas AD. Efficacy, predictors of response, and long-term follow up in patients with vitiligo treated with narrowband UVB phototherapy. J Am Acad Dermatol. 2007;56:274-8.
26. El Mofty M, Mostafa W, Esmat S, Youssef R, Azzam O, Hunter N, El Hanafi G, Fawzi M. Narrow band ultraviolet B 311 nm in the treatment of vitiligo: two right-left comparison studies. Photodermatol Photoimmunol Photomed. 2006;22:6-11.
27. Yones SS, Palmer RA, Garibaldinos TM, Hawk JL. Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UV-A therapy vs narrowband-UV-B therapy. Arch Dermatol. 2007;143:578-84.
28. Leone G, Pacifico A, Iacovelli P, Paro VA, Picardo M. Tacalcitol and narrow-band phototherapy in patients with vitiligo. Clin Exp Dermatol. 2006;31:200-5.
29. Diffey BL. Factors affecting the choice of a ceiling on the number of exposures with TL-01 ultraviolet B phototherapy. Br J Dermatol. 2003;149:428-30.
30. Steele MC, Diffey BL. A disposable face mask for PUVA and ultraviolet phototherapy. Br J Dermatol. 1997;137:151-2.
31. Dogra S, Kanwar AJ. Narrowband UVB phototherapy in dermatology. Indian J Dermatol Venereol Leprol. 2004;70:205-9.
32. Tjioe M, Gerritsen MJ, Juhlin L, van de Kerkhof PC. Treatment of vitiligo vulgaris with narrow band UVB (311 nm) for one year and the effect of addition of folic acid and vitamin B12. Acta Derm Venereol. 2002;82:369-72.
33. Lee Y, Seo YJ, Lee JH, Park JK. High-dose prednisolone and psoralen ultraviolet A combination therapy in 36 patients with vitiligo. Clin Exp Dermatol. 2007;32:499-501.
34. Radakovic-Fijan S, Fürnsinn-Friedl AM, Hönigsmann H, Tanew A. Oral dexamethasone pulse treatment for vitiligo. J Am Acad Dermatol. 2001;44:814-7.
35. Adisen E, Karaca F, Oztas M, Gürer MA. Efficacy of local psoralen ultraviolet A treatments in psoriasis, vitiligo and eczema. Clin Exp Dermatol. 2008;33:344-5.
36. Kreuter A, Gambichler T, Avermaete A, Jansen T, Altmeyer P, von Kobyletzki G. Localized vitiligo successfully treated with cream psoralen + ultraviolet A. J Eur Acad Dermatol Venereol. 2001;15:357-8.
37. Sehgal VN, Srivastava G. Vitiligo treatment options: An evolving scenario. J Dermatolog Treat. 2006;17:262-75.
38. Tjioe M, Otero ME, van de Kerkhof PC, Gerritsen MJ. Quality of life in vitiligo patients after treatment with longterm narrowband ultraviolet B phototherapy. J Eur Acad Dermatol Venereol. 2005;19:56-60.
39. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Am Acad Dermatol. 2010;62:114-35.
40. Herr H, Cho HJ, Yu S. Burns caused by accidental overdose of photochemotherapy (PUVA). Burns. 2007;33:372-5.
41. Voss A, Leverkus M, Bröcker EB, Goebeler M. Topical psoralen photochemotherapy with lethal outcome. Arch Dermatol. 2001;137:383.
42. Goktas EO, Aydin F, Senturk N, Canturk MT, Turanli AY. Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo. J Eur Acad Dermatol Venereol. 2006;20:553-7.
43. Yalçin B, Sahin S, Bükülmez G, Karaduman A, Atakan N, Akan T, et al. Experience with calcipotriol as adjunctive treatment for vitiligo in patients who do not respond to PUVA alone: a preliminary study. J Am Acad Dermatol. 2001;44:634-7.
44. Lotti T, Berti S, Moretti S. Vitiligo therapy. Expert Opin Pharmacother. 2009;10:2779-85.
45. Leone G, Pacifico A, Iacovelli P, Paro Vidolin A, Picardo M. l. Tacacitol and narrow-band phototherapy in patients with vitiligo. Clin Exp Dermatol. 2006;31:200-5.
46. Arca E, Tastan HB, Erbil AH, Sezer E, Koç E, Kurumlu Z. Narrow-band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo. J Dermatol. 2006;33:338-43.
47. Baysal V, Yildirim M, Erel A, Kesici D. Is the combination of calcipotriol and PUVA effective in vitiligo? J Eur Acad Dermatol Venereol. 2003;17:299-302.
48. Aristizábal AM, Echeverri MA, Zuluaga A, Jiménez SB, Manrique-Hernández RD. Comparación de calcitriol más PUVA con respecto a la monoterapia con PUVA en pacientes con psoriasis. Rev CES Med. 2009 23 (1) (Supl.): 87-96
49. Banerjee K, Barbhuiya JN, Ghosh AP, Dey SK, Karmakar PR. The efficacy of low-dose oral corticosteroids in the treatment of vitiligo patient. Indian J Dermatol Venereol Leprol. 2003;69:135-7.
50. Kanwar AJ, Dhar S, Dawn G. Oral minipulse therapy in vitiligo. Dermatology. 1995;190:251-2.
51. Rath N, Kar HK, Sabhnani S. An open labeled, comparative clinical study on efficacy and tolerability of oral minipulse of steroid (OMP) alone, OMP with PUVA and broad/narrow band UVB phototherapy in progressive vitiligo. Indian J Dermatol Venereol Leprol. 2008;74:357-60.
52. Njoo MD, Spuls PI, Bos JD, Westerhof W, Bossuyt PM. Nonsurgical repigmentation therapies in vitiligo. Meta-analysis of the literature. Arch Dermatol. 1998;134:1532-40.
53. Lee KJ, Choi YL, Kim JA, Kim MG, Lee JH, Yang JM, Lee DY. Combination therapy of epidermal graft and systemic corticosteroid for vitiligo. Dermatol Surg. 2007;33:1002-3
54. Lahiri K, Malakar S, Sarma N, Banerjee U. Repigmentation of vitiligo with punch grafting and narrow-band UV-B (311 nm) –a prospective study. Int J Dermatol. 2006;45:649-55.
55. Lahiri K, Malakar S, Sarma N, Banerjee U. Inducing repigmentation by regrafting and phototherapy (311 nm) in punch grafting failure cases of lip vitiligo: a pilot study. Indian J Dermatol Venereol Leprol. 2004;70:156-8.
56. Carlie G, Ntusi NB, Hulley PA, Kidson SH. KUVA (khellin plus ultraviolet A) stimulates proliferation and melanogenesis in normal human melanocytes and melanoma cells in vitro. Br J Dermatol. 2003;149:707-17.
57. Marconi B, Mancini F, Colombo P, Allegra F, Giordano F, Gazzaniga A, et al. Distribution of khellin in excised human skin following iontophoresis and passive dermal transport. J Control Release. 1999;60:261-8.
58. Dell´Anna ML, Mastrofrancesco A, Sala R, Venturini M, Ottaviani M, Vidolin AP, et al. Antioxidants and narrow bandUVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol. 2007;32:631-6.
59. Akyol M, Celik VK, Ozcelik S, Polat M, Marufihah M, Atalay A. The effects of vitamin E on the skin lipid peroxidation and the clinical improvement in vitiligo patients treated with PUVA. Eur J Dermatol. 2002;12:24-6.
2. Spritz RA, Gowan K, Bennett DC, Fain PR. Novel vitiligo susceptibility loci on chromosomes 7 (AIS2) and 8 (AIS3), confirmation of SLEV1 on chromosome 17, and their roles in an autoimmune diathesis. Am J Hum Genet. 2004;74:188-91.
3. Lotti T, Gori A, Zanieri F, Colucci R, Moretti S. Vitiligo: new and emerging treatments. Dermatol Ther. 2008;21:110-7.
4. Le Poole IC, Luiten RM. Autoimmune etiology of generalized vitiligo. Curr Dir Autoimmun. 2008;10:227-43.
5. Taïeb A, Picardo M. Vitiligo. N Engl J Med 2009;8;360:160-9.
6. Taïeb A, Picardo M. The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. Pigment Cell Res. 2007;20:27-35.
7. Bhatnagar A, Kanwar AJ, Parsad D, De D. Psoralen and ultraviolet A and narrow-band ultraviolet B in inducing stability in vitiligo, assessed by vitiligo disease activity score: an open prospective comparative study. J Eur Acad Dermatol Venereol. 2007;21:1381-5.
8. Njoo MD, Das PK, Bos JD, Westerhof W. Association of the Köbner phenomenon with disease activity and therapeutic responsiveness in vitiligo vulgaris. Arch Dermatol. 1999;135:407-13 .
9. Forschner T, Buchholtz S, Stockfleth E. Current state of vitiligo therapy – evidence-based analysis of the literature. J Dtsch Dermatol Ges. 2007;5:467-75.
10. Kostovic K, Pasic A. New treatment modalities for vitiligo: focus on topical immunomodulators. Drugs. 2005;65:447-59.
11. Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Whitton ME, Watts MJ, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008;159:1051-76.
12. Hamzavi I, Jain H, McLean D, Shapiro J, Zeng H, Lui H. Parametric modelling of narrow band UV-B phototherapy for vitiligo using a novel quantitative tool. Arch Dermatol. 2004;140:677-83.
13. Brazzelli V, Antoninetti M, Palazzini S, Barbagallo T, De Silvestri A, Borroni G. Critical evaluation of the variants influencing the clinical response of vitiligo: study of 60 cases treated with ultraviolet B narrowband phototherapy. J Eur Acad Dermatol Venereol. 2007;21:1369-74.
14. Njoo MD, Westerhof W. Vitiligo. Pathogenesis and treatment. Am J Clin Dermatol. 2001;2:167-81.
15. Fai D, Cassano N, Vena GA. Narrow-band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients. J Eur Acad Dermatol Venereol. 2007;21:916-20.
16. Firooz A, Bouzari N, Fallah N, Ghazisaidi B, Firoozabadi MR, Dowlati Y. What patients with vitiligo believe about their condition. Int J Dermatol. 2004;43:811-4.
17. Kist JM, van Voorhees AS. Narrowband ultraviolet B therapy for psoriasis and other skin disorders. Adv Dermatol. 2005;21:235-50.
18. Mason CP, Gawkrodger DJ. Vitiligo presentation in adults. Clin Exp Dermatol. 2005;30:344-5.
19. Sitek JC, Loeb M, Ronnevig JR. Narrowband UVB therapy for vitiligo: does the repigmentation last? J Eur Acad Dermatol Venereol. 2007;21:891-6.
20. Parsad D, Kanwar AJ, Kumar B. Psoralen-ultraviolet A vs. narrow-band ultraviolet B phototherapy for the treatment of vitiligo. J Eur Acad Dermatol Venereol. 2006;20:175-7.
21. Kanwar AJ, Dogra S, Parsad D, Kumar B. Narrow-band UVB for the treatment of vitiligo: an emerging effective and welltolerated therapy. Int J Dermatol. 2005;44:57-60.
22. Dogra S, Parsad D. Combination of narrowband UV-B and topical calcipotriene in vitiligo. Arch Dermatol. 2003;139:393.
23. Hercogová J, Buggiani G, Prignano F, Lotti T. A rational approach to the treatment of vitiligo and other hypomelanoses. Dermatol Clin. 2007;25:383-92.
24. Koca R, Armutcu F, Altinyazar HC, Gürel A. Oxidant-antioxidant enzymes and lipid peroxidation in generalized vitiligo. Clin Exp Dermatol. 2004;29:406-9.
25. Nicolaidou E, Antoniou C, Stratigos AJ, Stefanaki C, Katsambas AD. Efficacy, predictors of response, and long-term follow up in patients with vitiligo treated with narrowband UVB phototherapy. J Am Acad Dermatol. 2007;56:274-8.
26. El Mofty M, Mostafa W, Esmat S, Youssef R, Azzam O, Hunter N, El Hanafi G, Fawzi M. Narrow band ultraviolet B 311 nm in the treatment of vitiligo: two right-left comparison studies. Photodermatol Photoimmunol Photomed. 2006;22:6-11.
27. Yones SS, Palmer RA, Garibaldinos TM, Hawk JL. Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UV-A therapy vs narrowband-UV-B therapy. Arch Dermatol. 2007;143:578-84.
28. Leone G, Pacifico A, Iacovelli P, Paro VA, Picardo M. Tacalcitol and narrow-band phototherapy in patients with vitiligo. Clin Exp Dermatol. 2006;31:200-5.
29. Diffey BL. Factors affecting the choice of a ceiling on the number of exposures with TL-01 ultraviolet B phototherapy. Br J Dermatol. 2003;149:428-30.
30. Steele MC, Diffey BL. A disposable face mask for PUVA and ultraviolet phototherapy. Br J Dermatol. 1997;137:151-2.
31. Dogra S, Kanwar AJ. Narrowband UVB phototherapy in dermatology. Indian J Dermatol Venereol Leprol. 2004;70:205-9.
32. Tjioe M, Gerritsen MJ, Juhlin L, van de Kerkhof PC. Treatment of vitiligo vulgaris with narrow band UVB (311 nm) for one year and the effect of addition of folic acid and vitamin B12. Acta Derm Venereol. 2002;82:369-72.
33. Lee Y, Seo YJ, Lee JH, Park JK. High-dose prednisolone and psoralen ultraviolet A combination therapy in 36 patients with vitiligo. Clin Exp Dermatol. 2007;32:499-501.
34. Radakovic-Fijan S, Fürnsinn-Friedl AM, Hönigsmann H, Tanew A. Oral dexamethasone pulse treatment for vitiligo. J Am Acad Dermatol. 2001;44:814-7.
35. Adisen E, Karaca F, Oztas M, Gürer MA. Efficacy of local psoralen ultraviolet A treatments in psoriasis, vitiligo and eczema. Clin Exp Dermatol. 2008;33:344-5.
36. Kreuter A, Gambichler T, Avermaete A, Jansen T, Altmeyer P, von Kobyletzki G. Localized vitiligo successfully treated with cream psoralen + ultraviolet A. J Eur Acad Dermatol Venereol. 2001;15:357-8.
37. Sehgal VN, Srivastava G. Vitiligo treatment options: An evolving scenario. J Dermatolog Treat. 2006;17:262-75.
38. Tjioe M, Otero ME, van de Kerkhof PC, Gerritsen MJ. Quality of life in vitiligo patients after treatment with longterm narrowband ultraviolet B phototherapy. J Eur Acad Dermatol Venereol. 2005;19:56-60.
39. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Am Acad Dermatol. 2010;62:114-35.
40. Herr H, Cho HJ, Yu S. Burns caused by accidental overdose of photochemotherapy (PUVA). Burns. 2007;33:372-5.
41. Voss A, Leverkus M, Bröcker EB, Goebeler M. Topical psoralen photochemotherapy with lethal outcome. Arch Dermatol. 2001;137:383.
42. Goktas EO, Aydin F, Senturk N, Canturk MT, Turanli AY. Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo. J Eur Acad Dermatol Venereol. 2006;20:553-7.
43. Yalçin B, Sahin S, Bükülmez G, Karaduman A, Atakan N, Akan T, et al. Experience with calcipotriol as adjunctive treatment for vitiligo in patients who do not respond to PUVA alone: a preliminary study. J Am Acad Dermatol. 2001;44:634-7.
44. Lotti T, Berti S, Moretti S. Vitiligo therapy. Expert Opin Pharmacother. 2009;10:2779-85.
45. Leone G, Pacifico A, Iacovelli P, Paro Vidolin A, Picardo M. l. Tacacitol and narrow-band phototherapy in patients with vitiligo. Clin Exp Dermatol. 2006;31:200-5.
46. Arca E, Tastan HB, Erbil AH, Sezer E, Koç E, Kurumlu Z. Narrow-band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo. J Dermatol. 2006;33:338-43.
47. Baysal V, Yildirim M, Erel A, Kesici D. Is the combination of calcipotriol and PUVA effective in vitiligo? J Eur Acad Dermatol Venereol. 2003;17:299-302.
48. Aristizábal AM, Echeverri MA, Zuluaga A, Jiménez SB, Manrique-Hernández RD. Comparación de calcitriol más PUVA con respecto a la monoterapia con PUVA en pacientes con psoriasis. Rev CES Med. 2009 23 (1) (Supl.): 87-96
49. Banerjee K, Barbhuiya JN, Ghosh AP, Dey SK, Karmakar PR. The efficacy of low-dose oral corticosteroids in the treatment of vitiligo patient. Indian J Dermatol Venereol Leprol. 2003;69:135-7.
50. Kanwar AJ, Dhar S, Dawn G. Oral minipulse therapy in vitiligo. Dermatology. 1995;190:251-2.
51. Rath N, Kar HK, Sabhnani S. An open labeled, comparative clinical study on efficacy and tolerability of oral minipulse of steroid (OMP) alone, OMP with PUVA and broad/narrow band UVB phototherapy in progressive vitiligo. Indian J Dermatol Venereol Leprol. 2008;74:357-60.
52. Njoo MD, Spuls PI, Bos JD, Westerhof W, Bossuyt PM. Nonsurgical repigmentation therapies in vitiligo. Meta-analysis of the literature. Arch Dermatol. 1998;134:1532-40.
53. Lee KJ, Choi YL, Kim JA, Kim MG, Lee JH, Yang JM, Lee DY. Combination therapy of epidermal graft and systemic corticosteroid for vitiligo. Dermatol Surg. 2007;33:1002-3
54. Lahiri K, Malakar S, Sarma N, Banerjee U. Repigmentation of vitiligo with punch grafting and narrow-band UV-B (311 nm) –a prospective study. Int J Dermatol. 2006;45:649-55.
55. Lahiri K, Malakar S, Sarma N, Banerjee U. Inducing repigmentation by regrafting and phototherapy (311 nm) in punch grafting failure cases of lip vitiligo: a pilot study. Indian J Dermatol Venereol Leprol. 2004;70:156-8.
56. Carlie G, Ntusi NB, Hulley PA, Kidson SH. KUVA (khellin plus ultraviolet A) stimulates proliferation and melanogenesis in normal human melanocytes and melanoma cells in vitro. Br J Dermatol. 2003;149:707-17.
57. Marconi B, Mancini F, Colombo P, Allegra F, Giordano F, Gazzaniga A, et al. Distribution of khellin in excised human skin following iontophoresis and passive dermal transport. J Control Release. 1999;60:261-8.
58. Dell´Anna ML, Mastrofrancesco A, Sala R, Venturini M, Ottaviani M, Vidolin AP, et al. Antioxidants and narrow bandUVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol. 2007;32:631-6.
59. Akyol M, Celik VK, Ozcelik S, Polat M, Marufihah M, Atalay A. The effects of vitamin E on the skin lipid peroxidation and the clinical improvement in vitiligo patients treated with PUVA. Eur J Dermatol. 2002;12:24-6.
Cómo citar
1.
Vélez N, González T, Bohórquez L, Montes AM, Hernández CA, Jiménez SB. Fototerapia y otras alternativas terapéuticas para el manejo del vitiligo, diez años de experiencia en el Servicio de Fototerapia del Centro Dermatológico de la Universidad CES. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 26 de febrero de 2019 [citado 18 de abril de 2024];18(3):149-5. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/326
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Cómo citar
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Vélez N, González T, Bohórquez L, Montes AM, Hernández CA, Jiménez SB. Fototerapia y otras alternativas terapéuticas para el manejo del vitiligo, diez años de experiencia en el Servicio de Fototerapia del Centro Dermatológico de la Universidad CES. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 26 de febrero de 2019 [citado 18 de abril de 2024];18(3):149-5. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/326
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