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Effects of a preceding fractional carbon dioxide laser on the outcome of combined local narrowband ultraviolet B and topical steroids in patients with vitiligo in difficult‐to‐treat areas
Author(s) -
Vachiramon Vasanop,
Chaiyabutr Chayada,
Rattanaumpawan Pinyo,
Kanokrungsee Silada
Publication year - 2016
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/lsm.22389
Subject(s) - medicine , vitiligo , clobetasol propionate , dermatology , carbon dioxide laser , adverse effect , lesion , randomized controlled trial , group b , surgery , psoriasis , laser , laser surgery , physics , optics
Background and Objective Conventional treatment of vitiligo on hands and feet often produces an unsatisfactory result. Various ablative treatment methods were tried with favorable results in facial, neck, and truncal areas. The aim of this study is to evaluate the efficacy and safety of combined fractional CO 2 laser, narrowband UVB (NB‐UVB) phototherapy, and topical clobetasol propionate in managing stable vitiligo in difficult‐to‐treat areas. Study Design A prospective randomized‐intraindividual study was conducted on 27 patients with 27 pair‐lesions of non‐segmental vitiligo on both hands. The lesions were randomized to receive treatment with fractional CO 2 laser, NB‐UVB phototherapy, and 0.05% clobetasol propionate cream (Group A) or NB‐UVB phototherapy and 0.05% clobetasol propionate cream (Group B). Fractional CO 2 laser was performed at 1‐week interval for 10 sessions. NB‐UVB phototherapy was administered twice weekly for 20 sessions. Patients were evaluated 12 weeks after the last treatment. Outcome was evaluated objectively based on standard digital photographs, patient satisfaction, and adverse events. Results Twenty‐six patients completed the study. Six vitiligious lesions (23.1%) in group A achieved good to excellent repigmentation compared with one lesion (3.9%) in group B ( P = 0.065). The overall mean improvement score was 1.35 (±1.38) in group A and 0.50 (±0.95) in group B ( P = 0.0004). Patients' satisfaction score was significantly higher for the lesions in group A than group B. Lesions on the dorsum of the hand showed a higher response rate than those on the fingers. No serious side‐effects were noted. Conclusion This study demonstrates that adding fractional CO 2 laser treatment to NB‐UVB phototherapy and topical steroids improves the repigmentation rate of vitiliginous lesions on hands in some patients. This technique may be offered to vitiligo patients who are unresponsive to other treatments. Lasers Surg. Med. 48:197–202, 2016. © 2015 Wiley Periodicals, Inc.