Efficacy, Anatomical Site Variations, and Compliance Barriers of Narrowband UVB Phototherapy in Libyan Vitiligo Patients

Abstract

Narrowband ultraviolet B (NB-UVB) remains a first-line therapy for generalized vitiligo, yet real-world outcome data from North Africa are limited. We conducted a retrospective clinical audit of 54 documented Libyan vitiligo cases treated with NB-UVB. Demographic, clinical, anatomical, and follow-up variables were retrospectively collected from the medical records of the dermatology outpatient clinic. Categorical variables were expressed using frequencies alongside their corresponding percentages. Associations with clinically meaningful response (VASI improvement ≥50%) were examined using chi-square testing, Monte Carlo exact p-values where expected counts were small, and Kruskal-Wallis testing for non-parametric group comparisons. Mean age was 34.8 ± 16.4 years; 28 patients (51.9%) were male. Non-segmental disease predominated (45/54, 83.3%). The median VASI improvement was 62.5%, and 38 patients (70.4%) achieved ≥50% improvement. Hands (34/54, 63.0%) and feet (33/54, 61.1%) were the commonest sites, while acral resistance was documented in 22 cases (40.7%). Regular dermatologist follow-up showed numerically better response than irregular follow-up (82.6% vs 46.7%; Monte Carlo exact p=0.053). Treatment fatigue was uncommon (4/54, 7.4%) but strongly linked to poor response (Monte Carlo exact p=0.034). NB-UVB produced meaningful repigmentation in most audited Libyan patients, but residual acral resistance and follow-up barriers limited optimal outcomes. Strengthening continuity of care and early counseling on treatment fatigue may improve effectiveness.