Phototherapy and Combination Therapies for Vitiligo Samia Esmat, MD a , Rehab A. Hegazy, MD a , Suzan Shalaby, MD a , Stephen Chu-Sung Hu, MBBS, MPhil b , Cheng-Che E. Lan, MD, PhD b, * INTRODUCTION Vitiligo is a disease characterized by disappear- ance of melanocytes from the skin. It can negatively influence the physical appearance of affected individuals, and may profoundly affect a person’s psychosocial function and quality of life. 1–4 There- fore, vitiligo should not be considered as merely a condition that affects a patient’s appearance, but needs to be actively treated in patients who seek medical help. Phototherapy has been used as the main treatment modality for patients with vitiligo. Different forms of phototherapy for vitiligo include broadband UVB (BB-UVB), narrowband UVB (NB-UVB), excimer light and excimer laser, and psoralen plus UVA (PUVA). PHOTOTHERAPY OF VITILIGO FROM EARLY AGES TO MODERN MEDICINE Historically, phototherapy was first used to treat vitiligo more than 3500 years ago in ancient Egypt and India, when ancient healers used ingestion or topical application of plant extracts (Ammi majus Conflicts of Interest: None declared. Funding Sources: None. a Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt; b Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan * Corresponding author. Department of Dermatology, Kaohsiung Medical University Hospital, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan. E-mail address: laneric@cc.kmu.edu.tw KEYWORDS  Vitiligo  Phototherapy  Narrowband ultraviolet B  Excimer KEY POINTS  Different forms of phototherapy for vitiligo include broadband UVB, narrowband UVB (NB-UVB), ex- cimer light and excimer laser, and psoralen plus UVA.  The main proposed mechanisms for induction of repigmentation in vitiligo by UV light include the induction of T-cell apoptosis, and stimulation of proliferation/migration of functional melanocytes in the perilesional skin and immature melanocytes in hair follicles.  Optimizing NB-UVB requires consideration of different factors that affect the phototherapy protocol.  Introducing the Vitiligo Working Group consensus to highlight possible answers to questions lack- ing evidence in phototherapy of vitiligo.  Focusing on common obstacles met during phototherapy of vitiligo and how to overcome them.  Different forms of combination therapies used with phototherapy in vitiligo and their various degrees of success. Dermatol Clin 35 (2017) 171–192 http://dx.doi.org/10.1016/j.det.2016.11.008 0733-8635/17/Ó 2016 Elsevier Inc. All rights reserved. derm.theclinics.com