This case involves a middle-aged patient in Colorado who was referred to a dermatologist for white spots on her hands, neck, and face. The physician recommended ultraviolet light phototherapy to the patient. The day after her first treatment the patient awoke with severe burns and pain on her face, neck, chin, and chest. She went to the physician the next day and treatment to her face was discontinued. She was prescribed a cool compress for discomfort, as well as topical ointments including CVS-brand Aloe Vera lotion. The Ultraviolet treatment was discontinued for one week and resumed the following week, which resulted in another burn to same area. She continued to visit the dermatologist for a number of treatments; however, her pain did not subside, causing her to seek another physician for a second opinion. She was treated with ointment and informed that she should not have been treated with ultraviolet light therapy. Additionally, the CVS-brand Aloe Vera, the subject of a concurrent class action lawsuit against Fruit of the Loom, allegedly worsened her burns due to its alleged use of antifreeze. As a result of her overall treatment, the patient suffered extensive burns and permanent scarring.
Question(s) For Expert Witness
- 1. Do you treat patients with vitiligo?
- 2. What are the indications for ultraviolet light therapy?
- 3. Have you lectured/published on this topic?
Expert Witness Response E-068368
As the director of the Ethnic Skin Program at a major medical school, I very regularly treat vitiligo. Ultraviolet light therapy therapy is used to treat a variety of inflammatory disorders, including vitiligo. However, narrowband UVB therapy is now considered the standard of care for treatment of vitiligo. In my opinion, indications for PUVA for treatment of vitiligo include lack of response to narrowband UVB therapy or if the latter is unavailable within a reasonable commuting distance for the patient. Narrowband UVB and PUVA have similar response rates (though some studies show narrowband UVB has slightly superior response rates), the risk of adverse effects is lower with narrowband UVB, and the color match between the normal skin and the regimented skin is better with narrowband UVB. I have lectured on this topic and am currently conducting a research study on narrowband UVB therapy and vitiligo.