A clinical trial and molecular study of photoadaptation in vitiligo.

Background: Photoadaptation to ultraviolet (UV) B phototherapy is due to both pigmentary and nonpigmentary influences.

Objectives: To measure photoadaptation in vitiliginous skin and to compare it with normal pigmented skin.

Methods: Seventeen patients with Fitzpatrick skin phototypes III-VI with vitiligo received six to nine UVB treatments, two to three times weekly. Minimal erythema dose (MED) testing was done at baseline and after all treatments; the percentage change in MED was analysed as a measure of photoadaptation. The percentage decrease in cyclobutane pyrimidine dimers (CPDs) over 24 h after a single exposure of 1 MED was analysed on vitiliginous and normal skin.

Results: The mean +/- SD percentage change in MED from before to after treatments was: treated vitiliginous skin 28.5 +/- 39.9% (P = 0.015), treated normal skin 35.9 +/- 49.9% (P = 0.015), untreated vitiliginous skin 11.9 +/- 22.6% (P =0.070), untreated normal skin 25.1 +/- 41.3% (P = 0.041). Of these patients, two-thirds had a positive percentage change in MED (photoadaptation). The mean amount of CPDs induced per megabase of DNA immediately after exposure was significantly higher in vitiliginous skin. The mean +/- SD percentage decrease in CPDs (rate of repair) in 24 h was 35.7 +/- 26.8% in vitiliginous skin (P = 0.027) and 46.2 +/- 19.5% in normally pigmented skin (P = 0.001); no difference was noted in the repair in vitiliginous skin compared with normal skin (P = 0.4).

Conclusions: Photoadaptation in vitiliginous and normal skin was observed in two-thirds of patients. Vitiliginous skin had significantly more CPDs following UVB exposure; the rate of repair of UVB-induced DNA damage was equivalent to that in normal skin.