PHOTOTHERAPY FOR THE TREATMENT OF VITILIGO

Abstract

Vitiligo is a chronic pigmentation disorder of complex etiology, resulting from the dynamic interaction between cellular oxidative stress, an abnormal immune response mediated by CD8+ T lymphocytes, and genetic predisposition. Oxidative stress in the epidermis and the activation of intracellular signaling pathways in keratinocytes are central hallmarks that perpetuate the destruction of melanocytes. Therapeutic management has evolved from photochemotherapy with ultraviolet A radiation (PUVA) to phototherapy with narrowband ultraviolet B (NB-UVB, 311 nm), currently consolidated as the gold standard for generalized forms due to its superior efficacy and greater safety profile. NB-UVB exerts multifactorial effects by inducing apoptosis of autoreactive T lymphocytes and stimulating the proliferation and migration of melanocytic stem cells located in the hair follicle. For localized lesions, targeted phototherapy with Excimer laser (308 nm) offers rapid and precise responses. Recent advances highlight the synergy between NB-UVB and JAK (Janus kinase) pathway inhibitors, which accelerate repigmentation by neutralizing the immune attack while light stimulates cell regeneration. Additionally, photobiomodulation emerges as a promising complementary strategy to modulate the oxidative microenvironment. Phototherapy, especially NB-UVB, remains the cornerstone of vitiligo treatment. The future of management lies in therapeutic personalization and the integration of new biological therapies and surgical techniques to optimize repigmentation stability and the well-being of patients affected by vitiligo.