Eficácia e segurança do 308-nm monochromatic excimer lamp (mel) comparado a outros equipamentos de fototerapia no tratamento do vitiligo: revisão sistemática com metanálise

• Ano de defesa: 2017
• Autor(a) principal: Lopes, Celso [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Vitiligo therapy; Phototherapy; Light therapy low intensity; Excimer loops; Ultraviolet therapy; Vitiligo Terapia; Fototerapia; Terapia com luz de baixa intensidade; Lasers de excimer; Terapia ultravioleta
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5497747; http://repositorio.unifesp.br/handle/11600/50044

Background: Various phototherapy methods are used to treat vitiligo; however, the recent emergence of new devices has heightened debate concerning the best treatment method. Objective: We aimed to systematically review and metaanalyze published data comparing the efficacy and adverse effects of monochromatic excimer lamps versus excimer laser and narrowband ultraviolet B (NB-UVB) in treating vitiligo. Methods: A systematic search of PubMed, EMBASE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), and clinical trials registries identified randomized controlled trials that included vitiligo patients, regardless of age, sex, or study language. We evaluated studies comparing excimer lamps with excimer laser or NB-UVB phototherapy. Results: The review included six studies (411 patients, 764 lesions). No study found significantly different efficacy between excimer lamps and excimer laser using the outcomes of ≥50% repigmentation (RR = 0.97, 95% CI 0.84-1.1; lesions = 412; studies = 3; I² = 0%; moderate quality evidence) and ≥75% repigmentation (RR = 0.96, 95% CI 0.71-1.30; lesions = 308; studies = 2; I² = 20%; moderate quality evidence). Likewise, no study found significant differences between excimer lamps and NB-UVB for ≥50% repigmentation (RR = 1.24, 95% CI 1.00 - 1.54; lesions = 352; studies = 3; I² = 0%; low quality evidence) or for ≥75% repigmentation (RR = 1.81, CI 95% 0.11 - 29.52; lesions = 64; studies = 2; I² = 57%; very low quality evidence). Adverse effects were mild, including pruritus, burning sensation, and dryness, none of which interrupted treatment. Conclusions: Excimer lamps, excimer laser, and NB-UVB are all safe and effective in repigmentation of vitiligo lesions. No significant difference between the equipments was found using the outcomes of ≥50% and ≥ 75% repigmentation. Adverse effects, in short time, were mild. To our knowledge, this is the first systematic review of the efficacy and safety of excimer lamp treatment for vitiligo.