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Prescribing and using vitiligo treatments: lessons from a nested process evaluation within the HI-Light vitiligo randomized controlled trial

Leighton, Paul; Chalmers, Joanne R.; Batchelor, Jonathan; Rogers, Andrew; Akram, Perways; Haines, Rachel H.; Meakin, Garry; White, Jennifer; Ravenscroft, Jane; Sach, Tracy; Santer, Miriam; Whitton, Maxine; Eleftheriadou, Victoria; Thomas, Kim S.


Associate Professor of Applied Health Services Research

Joanne R. Chalmers

Jonathan Batchelor

Andrew Rogers

Perways Akram

Rachel H. Haines

Jane Ravenscroft

Tracy Sach

Miriam Santer

Maxine Whitton

Victoria Eleftheriadou


Background: The HI-Light Trial demonstrated that for active, limited vitiligo, combination treatment with potent topical corticosteroid (TCS) and handheld narrowband ultraviolet B offers a better treatment response than potent TCS alone. However, it is unclear how to implement these findings. Aim: We sought to answer three questions: (i) Can combination treatment be used safely and effectively by people with vitiligo?; (ii) Should combination treatment be made available as routine clinical care?; and (iii) Can combination treatment be integrated within current healthcare provision?. Methods: This was a mixed-methods process evaluation, including semi-structured interviews with a purposive sample of trial participants, structured interviews with commissioners, and an online survey and focus groups with trial staff. Transcripts were coded by framework analysis, with thematic development by multiple researchers. Results: Participants found individual treatments easy to use, but the combination treatment was complicated and required nurse support. Both participants and site investigators felt that combination treatment should be made available, although commissioners were less certain. There was support for the development of services offering combination treatment, although this might not be prioritized above treatment for other conditions. A ‘mixed economy’ model was suggested, involving patients purchasing their own devices, although concerns regarding the safe use of treatments mean that training, monitoring and ongoing support are essential. The need for medical physics support may mean that a regional service is more practical. Conclusion: Combination treatment should be made available for people seeking treatment for vitiligo, but services require partnership with medical physics and ongoing training and support for patients.


Leighton, P., Chalmers, J. R., Batchelor, J., Rogers, A., Akram, P., Haines, R. H., …Thomas, K. S. (2022). Prescribing and using vitiligo treatments: lessons from a nested process evaluation within the HI-Light vitiligo randomized controlled trial. Clinical and Experimental Dermatology, 47(8), 1480-1489.

Journal Article Type Article
Acceptance Date Mar 23, 2022
Online Publication Date May 30, 2022
Publication Date May 30, 2022
Deposit Date May 9, 2022
Publicly Available Date May 31, 2023
Journal Clinical and Experimental Dermatology
Print ISSN 0307-6938
Electronic ISSN 1365-2230
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 47
Issue 8
Pages 1480-1489
Keywords Dermatology
Public URL
Publisher URL
Additional Information Received: 2021-12-01; Accepted: 2022-03-23; Published: 2022-05-30


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