title: Effect of narrow band ultraviolet B phototherapy as monotherapy or combination therapy for vitiligo: a meta-analysis.
abstract: BACKGROUND
  The treatment of vitiligo is still one of the most difficult dermatological challenges, although there are many therapeutic options. Narrow band ultraviolet B (NB-UVB) phototherapy is considered to be a very important modality for generalized vitiligo.
  
  
  OBJECTIVE
  The aim of this study was to explore whether a combination of NB-UVB and topical agents would be superior to NB-UVB alone for treating vitiligo.
  
  
  METHODS
  We searched the electronic databases such as PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary outcome was the proportion of ≥50% repigmentation (a clinical significance), and secondary outcome was the proportion of ≥75% repigmentation (an excellent response).
  
  
  RESULTS
  Seven randomized controlled trials (RCTs) involving 240 patients (413 lesions) were included in this meta-analysis. The study showed no significant difference between NB-UVB combination therapy (NB-UVB and topical calcineurin inhibitor or vitamin D analogs) and NB-UVB monotherapy in the outcomes of ≥50% repigmentation and ≥75% repigmentation. However, lesions located on the face and neck had better results in ≥50% repigmentation (RR = 1.40, 95% CI 1.08-1.81) and ≥75% repigmentation (RR = 1.88, 95% CI 1.10-3.20) with NB-UVB and topical calcineurin inhibitor combination therapy vs. NB-UVB monotherapy.
  
  
  CONCLUSIONS
  The meta-analysis suggested that adding neither topical calcineurin inhibitors nor topical vitamin-D3 analogs on NB-UVB can yield significantly superior outcomes than NB-UVB monotherapy for treatment of vitiligo. However, addition of topical calcineurin inhibitors to NB-UVB may increase treatment outcomes in vitiligo affecting face and neck.
authors.affiliation: Department of Dermatology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Ronghua
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Dermatology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Qiao
authors.affiliation: Department of Dermatology, Qingdao Municipal Hospital (Group), Qingdao, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Dermatology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Xintong
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Dermatology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Sun
mesh_terms: D000279:Administration, Cutaneous; D065095:Calcineurin Inhibitors / Q000008:administration & dosage*; D002117:Calcitriol / Q000008:administration & dosage / Q000031:analogs & derivatives; D059248:Chemoradiotherapy; D003879:Dermatologic Agents / Q000008:administration & dosage; D004100:Dihydroxycholecalciferols / Q000008:administration & dosage; D005148:Facial Dermatoses / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D009333:Neck; D016032:Randomized Controlled Trials as Topic; D012880:Skin Pigmentation / Q000187:drug effects / Q000528:radiation effects; D016559:Tacrolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D014467:Ultraviolet Therapy / Q000379:methods*; D014807:Vitamin D / Q000031:analogs & derivatives*; D014820:Vitiligo / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D065095:Calcineurin Inhibitors; D003879:Dermatologic Agents; D004100:Dihydroxycholecalciferols; D014807:Vitamin D; C055085:calcipotriene; C023850:1 alpha,24-dihydroxyvitamin D3; C117268:pimecrolimus; D002117:Calcitriol; D016559:Tacrolimus
keywords: narrow band ultraviolet B; topical calcineurin inhibitors; vitamin-D3 analogs; vitiligo