关键词: 白癜风, 紫外线疗法, 围白斑照射法

Abstract: 【Abstract】 Objective To investigate clinical efficacy of narrow-band ultraviolet B （NB-UVB） irradiation around vitiliginous lesions in the treatment of refractory vitiligo. Methods A total of 126 patients with refractory vitiligo were retrospectively collected from Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University from June 2019 to November 2020. The patients were treated with NB-UVB irradiation around vitiliginous lesions after partial covering （perilesional irradiation group）, or conventional NB-UVB irradiation （conventional irradiation group）, twice a week for 3 consecutive months. After the treatment, the efficacy was evaluated. By using the propensity score method, the lesions in the 2 groups were matched at a ratio of 1∶1. Univariate and multivariate logistic regression analyses and stratified analysis were used to analyze the clinical efficacy of NB-UVB irradiation around vitiliginous lesions in the treatment of refractory vitiligo. Results Totally, there were 420 skin lesions in the perilesional irradiation group and 257 in the conventional irradiation group, and 190 lesions were enrolled into each group by propensity-score matching. Before and after the matching, the response rates were both significantly higher in the perilesional irradiation group （71.9%, 67.9%, respectively） than in the conventional irradiation group （31.9%, 30.0%, respectively, both P < 0.05）. After the propensity-score matching, both univariate and multivariate logistic regression analyses showed significant differences in the efficacy between the perilesional irradiation group and conventional irradiation group （OR = 4.9, 95% CI: 3.2, 7.6, P < 0.001; OR = 12.0, 95% CI: 6.5, 22.3, P < 0.001, respectively）. Vitiliginous lesions were classified according to hair types and irradiation methods: before the matching, there were 187 vitiliginous lesions with white hairs treated with the conventional irradiation and 246 treated with the perilesional irradiation, and there were 70 vitiliginous lesions with black hairs treated with the conventional irradiation and 174 treated with the perilesional irradiation; after the matching, 140 vitiliginous lesions with white hairs and 50 with black hairs were enrolled into each radiation group. Stratified analysis showed that the response rates of vitiliginous lesions with white hairs were significantly higher in the perilesional irradiation group （77.6%, 72.8%, respectively） than in the conventional irradiation group before and after the matching （19.3%, 20.7%, respectively, both P < 0.01）; for the vitiliginous lesions with black hairs, there was no significant difference in the response rate between the 2 groups （P = 0.908）. Conclusion The efficacy of NB-UVB irradiation around vitiliginous lesions is superior to the conventional irradiation in the treatment of refractory vitiligo, especially vitiliginous lesions with white hairs.

Key words: Vitiligo, Ultraviolet therapy, Irradiation around vitiliginous lesions