Is a plateau after early response common?
Short answerThe research behind this page cannot say. The largest pooled review of narrowband UVB counted how many people had responded at 6 months and at 12 months. But each count came from a different set of studies. It never followed one group of early responders to see how many later stalled. A plateau in your own course is still real. How common that is across everyone is not something these numbers can show. Evidence Evidence
More detail
The same review does show that response varies widely by person, by body site, and over months of treatment. Vitiligo guidance also expects a long course before results are judged. The next answer gives those numbers, including how many people did not reach each bar.
What depends on your situation
Those pooled snapshots cannot tell you a plateau is common, and they cannot predict one person’s course. No chart can say whether your response has ended, paused, or will pick up again.
Questions for your care team
- Is my course still inside the range you would expect?Saving keeps this on your device and needs JavaScript, which is off in this browser.
- What would tell us whether this plateau has settled?Saving keeps this on your device and needs JavaScript, which is off in this browser.
How many people did narrowband UVB not work for?
Short answerThe same pooled review answers that, if you read its percentages the other way round. At 12 months it reports two separate pools. One is 512 people across 8 studies, for the quarter-back bar. The other is 540 people across 9 studies, for the three-quarters bar: Evidence
- 25.0% had less than a quarter of their pigment back. About one person in four. That is the 75.0% our phototherapy page publishes, taken away from 100.
- 64.3% had less than three quarters back, from the same page’s 35.7%.
- On hands and feet, pooled separately after at least 6 months, 89.0% had less than a quarter back, from that page’s 11.0%. Nobody reached three quarters.
More detail
Each figure above names the published percentage it came from, so you can follow the link and check the arithmetic yourself. Nothing was pooled again to produce them: each side of a pair is just the other subtracted from 100. The hands and feet numbers come from 172 people in 6 studies. The review kept people who stopped early where it could, and otherwise counted the group at the final assessment. So a pool is not guaranteed to hold everyone who enrolled.
What depends on your situation
The pooled arms had no untreated comparison. So the review cannot say what would have happened to these people without treatment, in either direction. It also does not report how many got worse while being treated. A plateau in your own course is not the same as being counted in one of these groups.
Questions for your care team
- Which of these figures is the closest match to my vitiligo and my priority areas?Saving keeps this on your device and needs JavaScript, which is off in this browser.
- What would change your mind about continuing?Saving keeps this on your device and needs JavaScript, which is off in this browser.
What is “maintenance,” and how do plateaus change the plan?
Short answerMaintenance means continuing some treatment after a response settles, to try to hold the result. After a plateau, a prescriber may continue, taper, pause, or stop the course. That decision belongs to your prescriber, working from your record and current guidance. Evidence Evidence
More detail
Phototherapy and vitiligo guidelines describe how clinicians weigh response when deciding whether a course continues. They place course and maintenance decisions with the prescribing team. International guidance also notes that evidence for narrowband UVB itself as a maintenance treatment is limited.
What depends on your situation
This page does not give session frequencies, course durations, or any dose. Guidance describes groups; only your prescriber can apply it to your course and goals.
Questions for your care team
- Which of continue, taper, pause, or stop are you weighing for me, and why?Saving keeps this on your device and needs JavaScript, which is off in this browser.
Is pausing or stopping a legitimate choice?
Short answerYes. Pausing or stopping can be a reasonable shared decision, not a failure. It can be revisited later. What changes after stopping is something your care team monitors with you. Evidence Evidence
More detail
Clinical guidance expects treatment plans to be reviewed against goals over time. Continuing is one outcome of that review, not the only one.
What depends on your situation
What your skin does after stopping cannot be promised in either direction. Agree with your care team on what to watch and when to check back in.
Questions for your care team
- If we pause now, how do we keep the door open to restarting later?Saving keeps this on your device and needs JavaScript, which is off in this browser.
What should I bring to the “is this still working” conversation?
Short answerBring your own record. Session history with any gaps, photos of the same areas over time, and notes on which body sites changed give the review something concrete. Evidence Evidence
More detail
A course review compares change over time. A dated record of sessions, interruptions, and photographs supports that comparison better than memory alone.
What depends on your situation
This page does not offer a scoring system or a self-assessment tool. What your record means, and what it changes, is your care team’s call.
Questions for your care team
- Which parts of my record are most useful for judging response?Saving keeps this on your device and needs JavaScript, which is off in this browser.
What should I ask the care team?
Short answerAsk the questions that can change the plan. How response is defined for your priority areas, what would justify continuing versus pausing, and what a stop would involve all belong on the table. Evidence Evidence
More detail
A review is most useful when it names the goal, the evidence for progress so far, and the conditions for each possible next step.
What depends on your situation
Only your prescriber can answer these for your course. The answers can change as your response, health, and goals change.
Questions for your care team
- How are we defining response for my priority areas?Saving keeps this on your device and needs JavaScript, which is off in this browser.
- What would make you recommend continuing versus pausing?Saving keeps this on your device and needs JavaScript, which is off in this browser.
- If we stop, what do we watch for, and when would restarting make sense?Saving keeps this on your device and needs JavaScript, which is off in this browser.
Applicability check
Who was studied?
These fields show what the cited evidence reports about the people and body sites behind outcome or safety claims. “Not reported” means the reviewed source omitted the field; “Pending exact source review” means SteadySkin has not made that determination yet.
The research behind this page cannot say. The largest pooled review of narrowband UVB counted how many people had responded at 6 months and at 12 months. But each count came from a different set of studies. It never followed one group of early responders to see how many later stalled. A plateau in your own course is still real. How common that is across everyone is not something these numbers can show.
- Age range
- Three of the pooled studies enrolled children only, 8 enrolled adults only, and 24 enrolled all ages. Reported mean ages ran from about 10 to about 49 years, and individual ages from 3 to 77.
- Condition subtype
- Generalized or nonsegmental vitiligo. Segmental vitiligo was not the subject of this pooled review.
- Severity or extent
- Extent requirements differed by study. Some required at least 2% of body surface, others 5%, 10%, 15%, 20% or more. Many studies did not state an extent.
- Sample size
- 1428 people across 35 prospective studies. 1201 people in 29 studies received narrowband UVB, and 227 people in 9 studies received PUVA.
- Geography and care setting
- The pooled studies came from Brazil, Bulgaria, Canada, Egypt, England, Greece, India, Iran, Iraq, Italy, Korea, Nepal, Norway, the Netherlands, Tunisia, Turkey and the United Arab Emirates. All were prospective studies, so treatment was given in a study setting.
- Skin tone or phototype
- Fitzpatrick skin types were listed study by study and spanned types I to VI, most often types II to V. Several studies did not record skin type.
- Race
- Not reported
- Ethnicity
- Not reported
- Body sites
- For narrowband UVB, face and neck, trunk, extremities, and hands and feet were pooled separately after at least 6 months. PUVA was not pooled by body site, because too few of the studies reported it.
What that means for this page: The 2017 review pooled separate sets of studies at 3, 6 and 12 months. It did not follow one group of early responders to count how many later stalled. The 2023 Task Force statement is expert consensus, not a patient group. Together they cannot say how common a plateau is, whether one person has reached one, or what comes next.
The same pooled review answers that, if you read its percentages the other way round. At 12 months it reports two separate pools. One is 512 people across 8 studies, for the quarter-back bar. The other is 540 people across 9 studies, for the three-quarters bar: 25.0% had less than a quarter of their pigment back. About one person in four. That is the 75.0% our phototherapy page publishes, taken away from 100. 64.3% had less than three quarters back, from the same page’s 35.7%. On hands and feet, pooled separately after at least 6 months, 89.0% had less than a quarter back, from that page’s 11.0%. Nobody reached three quarters.
- Age range
- Three of the pooled studies enrolled children only, 8 enrolled adults only, and 24 enrolled all ages. Reported mean ages ran from about 10 to about 49 years, and individual ages from 3 to 77.
- Condition subtype
- Generalized or nonsegmental vitiligo. Segmental vitiligo was not the subject of this pooled review.
- Severity or extent
- Extent requirements differed by study. Some required at least 2% of body surface, others 5%, 10%, 15%, 20% or more. Many studies did not state an extent.
- Sample size
- The review as a whole pooled 1201 people across 29 narrowband UVB studies. Each figure inverted here rests on a smaller subset. The 12-month quarter-back bar used 512 people in 8 studies. The three-quarters bar used 540 people in 9 studies. The hands-and-feet pool used 172 people in 6 studies.
- Geography and care setting
- The pooled studies came from Brazil, Bulgaria, Canada, Egypt, England, Greece, India, Iran, Iraq, Italy, Korea, Nepal, Norway, the Netherlands, Tunisia, Turkey and the United Arab Emirates. All were prospective studies, so treatment was given in a study setting.
- Skin tone or phototype
- Fitzpatrick skin types were listed study by study and spanned types I to VI, most often types II to V. Several studies did not record skin type.
- Race
- Not reported
- Ethnicity
- Not reported
- Body sites
- For narrowband UVB, face and neck, trunk, extremities, and hands and feet were pooled separately after at least 6 months. PUVA was not pooled by body site, because too few of the studies reported it.
What that means for this page: These are arithmetic complements of pooled group averages, not a second pooling. The studies were published up to January 2016. The review kept people who stopped early where it could, and otherwise counted the group at final assessment. So a pooled figure is not guaranteed to hold everyone enrolled. The single-arm pooling had no untreated comparison. The review does not report how many people worsened. None of this predicts one person or one patch.
Maintenance means continuing some treatment after a response settles, to try to hold the result. After a plateau, a prescriber may continue, taper, pause, or stop the course. That decision belongs to your prescriber, working from your record and current guidance.
- Age range
- Not reported
- Condition subtype
- Not reported
- Severity or extent
- Not reported
- Sample size
- Not reported
- Geography and care setting
- The narrowband UVB guideline is written for UK phototherapy services, in clinic and at home. The Task Force statement is a worldwide expert position for primary and specialist care. Neither reports a study population of its own.
- Skin tone or phototype
- Not reported
- Race
- Not reported
- Ethnicity
- Not reported
- Body sites
- The narrowband UVB guideline notes that likely response varies by site, giving the face and trunk against the hands and feet as the example. Neither document reports a patient group for this plan-review point.
What that means for this page: These are consensus guidance documents, not a study of one group of people. They ask the prescribing team to review the response so far, from photographs and the person’s record, and to weigh the risks and burden of a longer course. The Task Force adds that evidence for narrowband UVB as a maintenance treatment is limited. They set no schedule or dose and estimate no outcome or risk for any one person.
Evidence behind this page
Sources
Each evidence badge opens the source and its limits. The full list stays available here.
- JAMA Dermatology (Bae JM, et al.)Systematic review · Clinical research, tier 2Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports the separate pooled repigmentation rates and participant counts the review reports for narrowband UVB and PUVA at 3, 6 and 12 months, and the narrowband UVB rates pooled by body region after at least 6 months. Each pooled figure rests on the subset of studies that reported that measure at that time, not on the full review. It also supports plainly labelled arithmetic complements of those reported rates.
What it does not support
The pooled arms are single-group, so they describe what happened to those groups, not what the light caused. The review planned an intention-to-treat count and kept people who stopped early where it could; otherwise it used the group described at the final assessment, so no pooled figure is guaranteed to cover every enrolled participant. It does not report how many people worsened during treatment, does not predict an individual course, and sets no device, schedule or dose.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- Journal of the European Academy of Dermatology and VenereologyGuideline · Regulatory / guideline, tier 1Relevant relationship disclosed
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: The journal is the publisher. This label refers to extensive author relationships disclosed for the recommendation, not to the journal itself.
What this source supports
It supports current expert-consensus terminology, clinical assessment, disease-activity evaluation, treatment-goal discussion, and shared decision-making. Its modified assessment check list names where the patches are as a disease feature, and gives genital involvement as its own example. It records white hairs as an item of its own, apart from what the vitiligo has done in the past six months. Its classification table keeps mucosal vitiligo as a subtype, both across more than one site and at one site alone. It supports planning care around what is there to work with, and its example is hair that still has its color.
What it does not support
It is not independent comparative proof. It cannot diagnose a reader from a description or photograph. It gives no figure for genital involvement, and it does not name lichen sclerosus. It does not set out the Vitiligo European Task Force grading scale. It puts no figure on white hairs and predicts nothing for one person.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- British Journal of Dermatology (Eleftheriadou V, et al.)Guideline · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports the clinical history and assessment domains, evaluation of associated autoimmune conditions, its recommendation for thyroid function and antithyroid antibody screening, current classification context, treatment-option map, psychosocial assessment, medical photography and the limits of pediatric evidence. Its classification table defines mucosal vitiligo as the oral or genital mucosae. One mucosal site alone is filed as undetermined or unclassified. Its differential diagnosis table lists genital or extragenital lichen sclerosus among the conditions that can be mistaken for vitiligo. That table also lists eczema, psoriasis, lichen planus, pityriasis alba and piebaldism. It calls autoimmunity a contributor to the pathogenesis of vitiligo. It reports an earlier review finding a possible negative impact on intimacy and sexual functioning. It tells clinicians to discuss the psychosocial impact of living with the condition.
What it does not support
It was designed for UK care and reviewed literature through May 2019; it does not establish a universal testing plan, prescribe an individual plan, or establish current US labeling or coverage. Its differential diagnosis table is a list, not a method a reader can apply to their own skin. It does not say how to tell any two of those conditions apart. It gives no figure for how often vitiligo affects genital skin.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- British Journal of Dermatology (Goulden V, et al.)Guideline · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
It supports that traditional NB-UVB fluorescent lamps emit a narrow UVB band peaking around 311 nanometres. It backs wearing UV-protective goggles and keeping UV scatter off people nearby. It records the consent form naming goggles and the same clothing at each session. It also covers clinical uses, how it compares with other light treatments, safety limits including sunburn-type reactions, and the added safeguards home phototherapy needs.
What it does not support
It does not provide a personal treatment plan, approve a particular home setup, or replace the instructions for your own device. SteadySkin never reproduces its treatment schedules.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.