The efficacy of ablation-based combination therapy for vitiligo: A systematic review and meta-analysis

The use of lasers in vitiligo, an overview

Various types of lasers have been demonstrated to be effective in the treatment of vitiligo. The mode of action of these lasers is just as varied as the purpose of intervention. Many clinicians are not aware of the unique opportunity these lasers offer to improve the outcomes of vitiligo treatment. To date, no clear overview exists of the use of lasers in vitiligo treatment. Thus, the aim of this review is to discuss the various types of lasers and provide an overview of the evidence for their efficacy. We found good evidence from a systematic review that the excimer laser is effective, induces repigmentation rates comparable to NB‐UVB and has improved outcomes when combined with calcineurin inhibitors. Ablative lasers are commonly used for tissue graft or melanocyte–keratinocyte cell graft transplantation. They provide safe, fast and uniform denudation of the epidermis with propitious repigmentation outcomes. We found conflicting evidence from two systematic reviews regarding the efficacy of fractional ablative lasers for improving outcomes of NB‐UVB therapy, a systematic review including only fractional ablative lasers provided evidence for efficacy. Q‐switched nanosecond lasers have shown to be safe and effective for inducing depigmentation, although recurrence is common, and most studies were small and retrospective. Despite proven efficacy and safety, laser treatments are relatively expensive and suited for limited body surface areas and selected cases. Each type of laser has benefits and risks associated and should, therefore, be individually chosen based on location, extent, activity and type of vitiligo.

Fractional versus full ablative CO2 laser in recipient site of non-cultured melanocytes and keratinocyte transplantation in treatment of vitiligo

BACKGROUND

Melanocyte-keratinocyte transplant procedure (MKTP) or non-cultured epidermal cell suspension transplantation is a very popular surgical modality for treating stable vitiligo. The recipient-site preparation is one potential determinant in the repigmentation outcomes.

AIM

To assess the efficacy of fractional CO₂ (FCO₂ ) laser in recipient-site preparation before MKTP and comparing it to the frequently used full surface laser ablation.

METHODS

This randomized comparative trial included 19 patients with 40 stable vitiligo lesions. In each patient, the treated sites were randomly categorized into two groups according to the recipient-site ablation (either fractional or full ablative CO₂ laser). Assessment of repigmentation was performed six months after the procedure.

RESULTS

Both modalities achieved successful repigmentation of a median of 80% and 77.5% for fractional and full ablation groups, respectively, with a non-statistically significant difference between them. The median of VASI change percent was -73% and -71% with fractional and full surface ablation, respectively.

CONCLUSIONS

FCO₂ laser ablation is effective for recipient-site preparation before cell suspension transplantation as well as the full ablative CO₂ laser.

The use of trichloroacetic acid as a depigmenting therapy in universal vitiligo

BACKGROUND AND OBJECTIVES

Several modalities have been used to clear residual facial pigmentation in patients with extensive vitiligo; however, the ideal depigmenting agent does not yet exist. The use of trichloroacetic acid (TCA) for depigmentation in universal vitiligo has been recently reported. We aim to evaluate the efficacy and safety of TCA 100 % as a depigmenting therapy for recalcitrant facial pigmentation in Egyptian patients with universal vitiligo.

PATIENTS AND METHODS

The study included 50 patients with universal vitiligo who had residual spotted pigmentation on the face causing psychological distress. TCA was focally applied to cover the pigmented patches at 100 % concentration. The treatment was repeated every two weeks until complete depigmentation or for a maximum of five treatment sessions.

RESULTS

Excellent response to TCA treatment (> 90 % depigmentation) was reported in 80 % of the studied cases, partial response (50-90 % depigmentation) in 12 % and poor response (< 50 % depigmentation) in 8 % of the cases. Minor adverse effects were reported e.g. burning sensation, erosions and local infection.

CONCLUSIONS

TCA seems to be a cost-effective and well tolerated therapeutic option for the treatment of recalcitrant residual pigmentation in patients with extensive vitiligo. This modality is associated with reduced downtime and minimal adverse effects.