Combination treatment by 10 600 nm ablative fractional carbon dioxide laser and narrowband ultraviolet B in refractory nonsegmental vitiligo: a prospective, randomized half-body comparative study

Authors

  • J. Shin,

    1. Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 134 Sinchon-Dong, Seodaemun-Gu, Seoul 120-752, Korea
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  • J.S. Lee,

    1. Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 134 Sinchon-Dong, Seodaemun-Gu, Seoul 120-752, Korea
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  • S-K. Hann,

    1. Korea Institute of Vitiligo Research and Drs Woo and Hann’s Skin Center, Seoul, Korea
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  • S.H. Oh

    1. Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 134 Sinchon-Dong, Seodaemun-Gu, Seoul 120-752, Korea
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  • Funding sources
    None.

  • Conflicts of interest
    None declared.

Sang Ho Oh.
E-mail: oddung93@yuhs.ac

Summary

Background  Vitiligo is a common acquired depigmentation disorder caused by the loss of melanocytes. Despite the numerous treatment modalities available for vitiligo, responses to treatment are still unsatisfactory. For this reason, new treatment modalities and approaches are needed.

Objectives  To investigate the effects of fractional carbon dioxide (CO2) laser therapy followed by systemic narrowband ultraviolet B (NB-UVB) phototherapy on nonsegmental vitiligo (NSV) as a prospective and randomized left-right comparative study.

Methods  Ten patients with NSV who presented symmetrical vitiligo lesions with no further improvement despite more than 1 year of conventional treatment were enrolled. Two sessions of half-body fractional CO2 laser therapy were performed at a 2-month interval. NB-UVB phototherapy was then administered to the entire body 5 days after each fractional laser treatment twice a week, increasing the dose incrementally by 15% at each session. Objective clinical assessments were made by two blinded dermatologists using a quartile grading scale, and the patients’ overall satisfaction was evaluated using a 10-point visual analogue scale.

Results  Two months after the last treatment, mean improvement scores, assessed by physicians, were significantly higher for those treated with half-body fractional CO2 laser therapy followed by NB-UVB phototherapy, compared with those treated with NB-UVB alone (= 0·034). In addition, according to subjective assessment, the half-body laser treatment followed by NB-UVB showed significantly higher improvements compared with NB-UVB treatment alone (= 0·023). Noticeable adverse events, such as infection, scarring and Koebner phenomenon, were not found in any patient.

Conclusions  This study suggests that fractional CO2 laser therapy followed by NB-UVB phototherapy could be used effectively and safely as an alternative modality for the treatment of refractory vitiligo.

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