The article below relates to Psoriasis. I believe that similar results would be found if this or a similar study were done with patients with Vitiligo. My suspicion would be that the results if the the study were done for Vitiligo would show that there would be a higher acceptance. Vitiligo does require a longer treatment regimen over many months and seldom do Vitiligo patients see any results in fewer than 40 to 60 treatments. (three to five months) and visiting a clinic every 2 days with no results showing and spending time in the car, money from your bank account tends to discourage folks. Vitiligo patients really do save significant money and time with home phototherapy.
Published 7 May 2009, doi:10.1136/bmj.b1542
Cite this as: BMJ 2009;338:b1542
Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)
Objective To determine whether ultraviolet B phototherapy athome is equally safe and equally effective as ultraviolet Bphototherapy in an outpatient setting for patients with psoriasis.
Design Pragmatic multicentre single blind randomised clinicaltrial (PLUTO study).
Setting Dermatology departments of 14 hospitals in the Netherlands.
Participants 196 patients with psoriasis who were clinicallyeligible for narrowband (TL-01) ultraviolet B phototherapy.The first 105 consecutive patients were also followed for oneyear after therapy.
Intervention Ultraviolet B phototherapy at home using a TL-01home phototherapy unit compared with standard narrowband ultravioletB phototherapy in an outpatient setting. Both therapies weredone in a setting reflecting routine daily practice in the Netherlands.
Main outcome measures The main outcome measure was effectivenessas measured by the proportion of patients with a 50% or morereduction of the baseline psoriasis area and severity index(PASI) or self administered psoriasis area and severity index(SAPASI), called the PASI 50 and SAPASI 50 (relevant treatmenteffect). Another outcome of effectiveness was the percentagereduction in median scores on the PASI as well as SAPASI. Alsothe proportions of patients reaching the PASI 75 and SAPASI75 (successful treatment effect), and the PASI 90 and SAPASI90 (almost complete clearance) were calculated. Other secondaryoutcomes were quality of life (SF-36, psoriasis disability index),burden of treatment (questionnaire), patients’ preferencesand satisfaction (questionnaire), and dosimetry and short termside effects (diary).
Results 82% of the patients treated at home compared with 79%of the patients treated in an outpatient setting reached theSAPASI 50 (difference 2.8%, 95% confidence interval -8.6%to 14.2%), and 70% compared with 73% reached the PASI 50 (-2.3%,-15.7% to 11.1%). For patients treated at home the medianSAPASI score decreased 82% (from 6.7 to 1.2) and the medianPASI score decreased 74% (from 8.4 to 2.2), compared with 79%(from 7.0 to 1.4) and 70% (from 7.0 to 2.1) for patients treatedin an outpatient setting. Treatment effect as defined by themean decline in PASI and SAPASI scores was significant (P<0.001)and similar across groups (P>0.3). Total cumulative dosesof ultraviolet B light were similar (51.5 v 46.1 J/cm2, difference5.4, 95% confidence interval -5.2 to 16.0), and the occurrenceof short term side effects did not differ. The burden of undergoingultraviolet B phototherapy was significantly lower for patientstreated at home (differences 1.23 to 3.01, all P 0.001). Qualityof life increased equally regardless of treatment, but patientstreated at home more often rated their experience with the therapyas “excellent” (42%, 38/90) compared with patients treated inthe outpatient department (23%, 20/88; P=0.001).
Conclusion Ultraviolet B phototherapy administered at home isequally safe and equally effective, both clinically and forquality of life, as ultraviolet B phototherapy administeredin an outpatient setting. Furthermore, ultraviolet B phototherapyat home resulted in a lower burden of treatment and led to greaterpatients’ satisfaction.