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Haghsay Khashechi E, Afaghmehr A, Heydari N, Barfar A, Shokri J. Laser-mediated Solutions: Breaking Barriers in Transdermal Drug Delivery. AAPS PharmSciTech 2024; 25:142. [PMID: 38898170 DOI: 10.1208/s12249-024-02849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Skin diseases pose challenges in treatment due to the skin's complex structure and protective functions. Topical drug delivery has emerged as a preferred method for treating these conditions, offering localized therapy with minimal systemic side effects. However, the skin's barrier properties frequently limit topical treatments' efficacy by preventing drug penetration into deeper skin layers. In recent years, laser-assisted drug delivery (LADD) has gained attention as a promising strategy to overcome these limitations. LADD involves using lasers to create microchannels in the skin, facilitating the deposition of drugs and enhancing their penetration into the target tissue. Several lasers, such as fractional CO2, have been tested to see how well they work at delivering drugs. Despite the promising outcomes demonstrated in preclinical and clinical studies, several challenges persist in implementing LADD, including limited penetration depth, potential tissue damage, and the cost of LADD systems. Furthermore, selecting appropriate laser parameters and drug formulations is crucial to ensuring optimal therapeutic outcomes. Nevertheless, LADD holds significant potential for improving treatment efficacy for various skin conditions, including skin cancers, scars, and dermatological disorders. Future research efforts should focus on optimizing LADD techniques, addressing safety concerns, and exploring novel drug formulations to maximize the therapeutic benefits of this innovative approach. With continued advancements in laser technology and pharmaceutical science, LADD has the potential to revolutionize the field of dermatology and enhance patient care.
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Affiliation(s)
| | | | - Niloofar Heydari
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ashkan Barfar
- Faculty of Pharmacy, Tabriz University of Medical Science, Tabriz, Iran
- Department of pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Shokri
- Department of pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
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Wang X, Wu W, Chen J, Li C, Li S. Management of the refractory vitiligo patient: current therapeutic strategies and future options. Front Immunol 2024; 14:1294919. [PMID: 38239366 PMCID: PMC10794984 DOI: 10.3389/fimmu.2023.1294919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024] Open
Abstract
Vitiligo is an autoimmune disease that leads to disfiguring depigmented lesions of skin and mucosa. Although effective treatments are available for vitiligo, there are still some patients with poor responses to conventional treatment. Refractory vitiligo lesions are mostly located on exposed sites such as acral sites and lips, leading to significant life stress. Understanding the causes of refractory vitiligo and developing targeted treatments are essential to enhance vitiligo outcomes. In this review, we summarized recent treatment approaches and some potential methods for refractory vitiligo. Janus kinase inhibitors have shown efficacy in refractory vitiligo. A variety of surgical interventions and fractional carbon dioxide laser have been widely applied to combination therapies. Furthermore, melanocyte regeneration and activation therapies are potentially effective strategies. Patients with refractory vitiligo should be referred to psychological monitoring and interventions to reduce the potential pathogenic effects of chronic stress. Finally, methods for depigmentation and camouflage may be beneficial in achieving uniform skin color and improved quality of life. Our ultimate focus is to provide alternative options for refractory vitiligo and to bring inspiration to future research.
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Affiliation(s)
| | | | | | | | - Shuli Li
- *Correspondence: Shuli Li, ; Chunying Li,
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3
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Ahlawat S, Kothiwala R, Meherda A. A Comparative Study to Evaluate the Efficacy of Fractional CO 2 Laser + PRP Vs. Fractional CO 2 Laser Alone in Patients with Vitiligo. J Cutan Aesthet Surg 2023; 16:186-191. [PMID: 38189059 PMCID: PMC10768947 DOI: 10.4103/jcas.jcas_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Introduction Vitiligo is a multifactorial acquired disorder clinically characterized by amelanotic lesions on the skin, due to destruction of melanocytes. The course of vitiligo is unpredictable. Vitiligo causes significant psychological impact and cosmetic disfigurement. Treatment of vitiligo is challenging and requires a multidisciplinary approach. Materials and Methods A prospective comparative interventional study was carried out from October 2018 to March 2020. The study enrolled 60 stable vitiligo patients divided into groups A and B. Group A (30 patients) was treated with both fractional CO2 laser and autologous platelet-rich plasma (PRP) injection. Group B (30 patients) was treated with fractional CO2 laser alone. A total of four sessions were conducted in each group at 1-month interval along with photographic assessment. Final assessment was done 1 month after the completion of four sessions. Results In group A, the median values of repigmentation and visual-analog score (VAS) were 3 and 7, and in group B, the median values of repigmentation and VAS were 1 and 2, respectively. Lesions over the trunk showed the best response followed by face and extremities lesions. Acral lesions showed the least response. Conclusion A combination of fractional CO2 laser and PRP is superior to fractional CO2 laser alone in the treatment of stable vitiligo.
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Affiliation(s)
- Shweta Ahlawat
- Department of Dermatology, JLN Medical College, Ajmer, Rajasthan, India
| | | | - Ashok Meherda
- Department of Dermatology, JLN Medical College, Ajmer, Rajasthan, India
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Eleftheriadou V, Bergqvist C, Kechichian E, Shourick J, Ju HJ, van Geel N, Bae JM, Ezzedine K. Has the core outcome (domain) set for vitiligo been implemented? An updated systematic review on outcomes and outcome measures in vitiligo randomized clinical trials. Br J Dermatol 2023; 188:247-258. [PMID: 36763863 DOI: 10.1093/bjd/ljac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND In 2015, a major achievement in vitiligo research was the development of an internationally agreed upon core outcome domain set for randomized clinical trials (RCTs). Three outcomes were identified as being essential: repigmentation, side-effects/harms and maintenance of gained repigmentation. Four items were further recommended for inclusion. The following recommendations then followed: repigmentation should be assessed by measuring the percentage of repigmentation in quartiles (0-25%, 26-50%, 51-79%, 80-100%) and cosmetic acceptability of the results should be assessed using the Vitiligo Noticeability Scale. OBJECTIVES The primary objective of this study was to assess uptake of the core outcome domain set for RCTs in vitiligo. Secondary objectives were to update the systematic review on outcomes reported in vitiligo RCTs, and to assess whether repigmentation and cosmetic acceptability of the results were measured using the above-mentioned recommended scales. METHODS We searched PubMed, Cochrane Library (CENTRAL and Systematic Reviews) and ClinicalTrials.gov for vitiligo RCTs between November 2009 and March 2021. Screening and data extraction were independently performed on title and summary by two researchers. All outcomes and outcome measures reported in eligible RCTs were retrieved and collated. RESULTS In total, 174 RCTs were identified: 62 were published between 2009 and 2015, and 112 were published between 2016 and 2021.Thirty-eight different outcomes were reported. Repigmentation was the primary outcome in 89% of trials (150 of 169). Forty-nine different tools were used to measure repigmentation. Side-effects and harms were reported in 78% of trials (136 of 174). Maintenance of gained repigmentation was reported in only 11% of trials (20 of 174) and duration of follow-up varied greatly from 1 to 14 months. Cosmetic acceptability of the results and cessation of disease activity were assessed in only 2% of trials (four of 174). Quality of life of patients with vitiligo was assessed in 13% of trials (22 of 174). Finally, only 11 of 112 RCTs (10%) published between 2016 and 2021 reported all three essential core outcome domains (repigmentation, side-effects and maintenance of gained repigmentation) and none of the trials reported both essential and recommended core outcome domains. CONCLUSIONS Efforts are still needed to close the gap between set recommendations and RCT outcome reporting.
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Affiliation(s)
- Viktoria Eleftheriadou
- Department of Dermatology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Christina Bergqvist
- Department of Dermatology, Henri Mondor University Hospital, Créteil, France
| | - Elio Kechichian
- Department of Dermatology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jason Shourick
- Department of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, Toulouse, France
| | - Hyun-Jeong Ju
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Jung Min Bae
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital, Créteil, France.,EA 7379 EpidermE, Faculty of Medicine, Université Paris-Est Créteil, UPEC, Créteil, France
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5
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Helou J, Soutou B, Maatouk I, Merhy R, Assaf J, Sarkis AS, Jabbour R, Kaikati J, Tomb R. Beneficial UVB phototherapy preceding a fractional CO 2 laser-UVB protocol in refractory non-segmental vitiligo. J Cosmet Dermatol 2022; 21:6783-6787. [PMID: 36121343 DOI: 10.1111/jocd.15396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/16/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To explore the short- and long-term effects of UVB phototherapy preceding a fractional CO2 laser-UVB protocol in patients with resistant nonsegmental vitiligo. MATERIALS AND METHODS This single-center, prospective, split-face/body, evaluator-blinded study included adult patients with stable vitiligo refractory to conventional treatments. Two symmetrical lesions were selected. Phototherapy was delivered with one side covered, until minimal erythema. Within 3 days, 31-month-apart sessions of laser were performed on both sides. After each laser session, phototherapy was resumed three times weekly, with all lesions uncovered, until 8 weeks after the last laser session. At baseline, at the end of treatment, and 5 years later, a Mean Improvement Score by Physician (MISP) and a patient satisfaction 10-point visual analog score (VAS) were recorded. RESULTS Ten patients (8 women and 2 men) were included; their mean age was 32.9 years; phototype III was predominant; the mean duration of vitiligo was 3 years. At the end of treatment and 5 years later, scores of lesions treated with UVB-CO2 -UVB (mean MISP 3.0 and 2.9, mean ΔVAS 4.5 and 3.9, respectively), were higher than those of lesions treated only with CO2 -UVB (mean MISP 2.5 and 2.4, mean ΔVAS 4.1 and 3.6, respectively). After 5 years, one patient lost his partial response and two patients developed light hyperpigmentation on both sides. CONCLUSION Exposure to UVB before CO2 -UVB explains the higher scores as it was the only variable between the two sides. It may improve the response of resistant lesions with a constantly sustained result over 5 years.
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Affiliation(s)
- Josiane Helou
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Dermatology Department, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Boutros Soutou
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Dermatology Department, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Ismael Maatouk
- Dermatology department, Clemenceau Medical center affiliated with Johns Hopkins, Beirut, Lebanon
| | - Reine Merhy
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Dermatology Department, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Joy Assaf
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Dermatology Department, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Anne-Sophie Sarkis
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Dermatology Department, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Rita Jabbour
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Dermatology Department, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Jérôme Kaikati
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Dermatology Department, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Roland Tomb
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Dermatology Department, Hôtel-Dieu de France Hospital, Beirut, Lebanon
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6
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Investigation of optimal energy or density of a fractional CO2 laser system in the treatment of stable non-segmental vitiligo. Complement Ther Clin Pract 2022; 49:101684. [DOI: 10.1016/j.ctcp.2022.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/13/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
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7
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Zou B, Zheng W, Pan H, Yang B, Liu Z. Research trends and hotspot analysis of fractional carbon dioxide laser: A bibliometric and visualized analysis via Citespace. J Cosmet Dermatol 2022; 21:5484-5499. [PMID: 35869829 DOI: 10.1111/jocd.15267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION There is limited basic research on carbon dioxide (CO2 ) fractional laser, indicating blind spots in CO2 fractional laser treatment of certain diseases. This study aimed to organize previous literature, summarize the current research, and speculate on possible future development. METHODS We searched document data on fractional CO2 lasers from the Web of Science core collection database and retrieved 928 articles from 2004 to 2021. CiteSpace software was used to analyze the main institutions, authors, subject hotspots, and research frontiers in global CO2 fractional laser research. RESULTS The results revealed that 928 related papers were published in the past 18 years (2004-2021), and the number has increased annually. The publications were written by 3239 authors from 626 institutions in 60 countries/regions. The United States (US) dominates this field (312 documents), followed by Italy (289), and South Korea (88). Lasers in Surgery and Medicine is the journal with the most publications and citations, and Uebelhoer is the central author. The main research hotspots include vulvovaginal atrophy, fractional photothermolysis, keloids, drug delivery, gene expressions, facial acne scarring, resurfacing, vitiligo, and photo damage. CONCLUSION Using CiteSpace, this paper draws a map of authors, institutions, and keywords in fractional CO2 laser from 2004 to 2021; summarizes the main authors, institutions, research hotspots, and cutting-edge topics of global fractional CO2 laser technology in recent years; and summarizes the current application status of global fractional CO2 laser in disease treatment. It also provides new ideas for the future application and research of fractional CO2 lasers.
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Affiliation(s)
- Boya Zou
- The First Clinical Medical College, Southern Medical University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Wenyue Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Hongju Pan
- Guangdong Provincial Engineering Technology Research and Development Center for External Drugs, Foshan City, Guangdong Province, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Zhenfeng Liu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
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8
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Abasifar H, Ghalamkarpour F, Diab R, Abdollahimajd F. Evaluation of Combination use of phenytoin Cream 1% and Fractional CO 2 laser in Treatment of Stable Non-Segmental Vitiligo: A Pilot Study. Dermatol Ther 2022; 35:e15635. [PMID: 35699662 DOI: 10.1111/dth.15635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vitiligo is an autoimmune disorder of melanocyte characterized by macular and depigmented patches. There are several treatment modalities for this disease, including the use of corticosteroids, calcineurin inhibitors, vitamin D analogous and topical phenytoin. Combination therapy utilizing fractional CO2 laser with different topical agents has been used to enhance treatment response with promising results. In this study, we aimed to evaluate the effect of fractional CO2 laser in combination with topical phenytoin. METHODS In this study, 25 patients (11 females and 14 males) with age of 18 to 59 (mean age of 31.12) with non-segmental stable vitiligo were recruited with insufficient response to at least one-year treatment with a monotherapy using topical corticosteroids, calcineurin inhibitors, and/or NB-UVB phototherapy. Patients were treated with a combination of fractional CO2 laser (10600 nm, pulse energy 30 to 50 mJ, MIXEL, South Korea, Rating: 220VAC, 3A, 50/60Hz) with monthly intervals for 6 sessions and application of phenytoin 1% cream twice daily. Photography was done before and after treatment with Wood's lamp. The severity of disease using VASI score was calculated and compared before and after treatment. RESULTS The mean VASI score before treatment was 0.55, and sixth month after treatment increased to 1.97 (p-value <0.001). Patients were divided into three groups based on the vitiligo subtype: acral, upper extremities, and trunk. VASI score was measured in each group: VASI score before and after treatment was 0.50 and 1.48 in acral areas, 0.45 and 2.04 in upper extremities and 0.79 and 3.39 in trunk, respectively. CONCLUSIONS This study revealed that combination therapy with phenytoin and fractional CO2 laser is effective in treatment of vitiligo not only in the upper extremities and trunk, but also interestingly in the acral areas. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hajar Abasifar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghalamkarpour
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reem Diab
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Abdollahimajd
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Research Development Unit, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Elgarhy LH, El-Tatawy RA, Ali DM, Anber DM, Iskandarani YA, Ismail MA. Treatment of stable nonsegmental vitiligo using transdermal delivery of 5-fluorouracil by fractional CO 2 laser versus intralesional injection of 5-fluorouracil, both followed by narrow-band type ultraviolet B (UVB): A comparative study. J Cosmet Dermatol 2022; 21:3832-3841. [PMID: 35005831 DOI: 10.1111/jocd.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Updates of treatment methods of stable vitiligo are needed to give better outcomes with a shorter duration of treatment. OBJECTIVE To test the effect of transdermal 5-fluorouracil (5-FU) delivery using fractional CO2 (FrCO2 ) laser versus intralesional 5-FU injection, with narrow-band type ultraviolet B (UVB) (NB-UVB) therapy after both, in the treatment of stable vitiligo. PATIENTS AND METHODS The present study comprised 40 patients with nearly symmetrical stable vitiligo lesions. The left side was treated with FrCO2 laser followed by topical 5-FU (FrCO2 + 5-FU), while the right side was treated with 5-FU intradermal injection. Both procedures were done at 2-week intervals for 3 sessions followed by 24 sessions of narrow-band UVB for both sides. RESULTS Repigmentation was demonstrated on the left side of 90% of patients and the right side of 85% of patients. As much as >50% improvement was demonstrated on the left side of 50% of patients, and the right side of 55% of patients. Intralesional 5-FU showed a statistically significant difference in repigmentation compared to FrCO2 + 5-FU. CONCLUSION Both 5-FU injection and FrCO2 + 5-FU were effective therapeutic modalities for vitiligo. Patients were more compliant with FrCO2 + 5-FU.
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Affiliation(s)
- Lamia H Elgarhy
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rania A El-Tatawy
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dareen M Ali
- Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doha M Anber
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Mayada A Ismail
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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10
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Mohammadi S, Amiri R, Khalili M, Iranmanesh B, Aflatoonian M. Treatment protocols and efficacy of combined laser with medical treatment modalities in vitiligo. J Cosmet Dermatol 2021; 21:3272-3291. [PMID: 34766697 DOI: 10.1111/jocd.14602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUNDS Nowadays, lasers are used for treatment of vitiligo in difficult-to-treat areas and refractory lesions. Combination of lasers with other medical modalities can provide higher efficacy, faster response rate, and higher compliance of patients to treatment. AIM In this article, we reviewed articles regarding safety, efficacy, and treatment protocols of combined laser with other medical modalities. METHODS We searched articles with relevant key words in Google scholar and PubMed. Inclusion criteria were articles in English language since January 2000 until March 2021that evaluate combination of laser with other topical or systemic medical treatments. RESULTS A total of 42 articles evaluated efficacy of lasers [excimer, carbon dioxide (CO2 ), erbium-doped yttrium-aluminum-garnet (Er:YAG), and non-ablative resurfacing laser] combined with topical or systemic medical treatment modalities. Effective response rate (more than 50% improvement) varied between 7.7% and 92%. Initial repigmentation observed between 4 and 13 weeks after beginning of treatment. CONCLUSION Combination of laser with medical modalities leads to more rapid repigmentation, superior efficacy, and better compliance of patients with localized non-segmental type of vitiligo compared to monotherapy. Combination of excimer laser with topical therapy might be suggested for recalcitrant vitiligo lesions in face and neck. Combination of fractional ablative resurfacing lasers with topical therapy, especially 5-flurouracil, can be recommended particularly in recalcitrant acral and bony prominent areas. Further studies are required to achieve conclusive evidence in order to define the best stage of vitiligo for laser therapy and most effective combined treatment regimen.
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Affiliation(s)
- Saman Mohammadi
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Rezvan Amiri
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Khalili
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Behzad Iranmanesh
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Aflatoonian
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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11
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Kanokrungsee S, Khunkhet S, Rojhirunsakool S, Thadvibun K, Sahaspot T. Triple combination therapy of narrowband ultraviolet B, fractional carbon dioxide laser and topical bimatoprost 0.01% for non-segmental vitiligo on non-facial areas: A randomized half-body, double-blind, placebo-controlled, comparative study. Dermatol Ther 2021; 35:e15198. [PMID: 34750933 DOI: 10.1111/dth.15198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/29/2021] [Accepted: 11/06/2021] [Indexed: 11/30/2022]
Abstract
Combination therapy shows superior outcomes over monotherapy in treating vitiligo. Topical bimatoprost is a melanogenic agent effectively used to induce repigmentation. However, topical bimatoprost 0.01% has never been explored in non-facial vitiligo, and triple therapy of phototherapy, fractional laser and topical bimatoprost has never been examined. This study aims to investigate the efficacy and safety of triple-modality treatment, combining narrowband ultraviolet B (NB-UVB), fractional carbon dioxide (CO2 ) laser and topical bimatoprost 0.01% for stable non-segmental vitiligo on non-facial areas. Fifteen vitiligo patients with at least two symmetrical, comparable-sized lesions on non-facial regions were included. The paired lesions were randomized to receive a treatment regimen of twice-daily application of either bimatoprost 0.01% solution or placebo in combination with once-monthly fractional CO2 laser and twice-weekly NB-UVB therapy for 12 weeks. There were no statistically significant differences in the vitiligo surface area (VSA) and melanin concentration (MC) at baseline between treatment sides. After 12 weeks of treatment, the percentage change from baseline of MC on the triple-therapy side was significantly higher than that on the dual-therapy side, 27.17 ± 13.62% versus 22.82 ± 10.10% (p = 0.028). The change from baseline of VSA was also greater on the triple-therapy side; however, a statistically significant difference was not reached. Improvement grades of repigmentation and adverse events were similar on both sides. Triple therapy with NB-UVB, fractional CO2 laser and topical bimatoprost 0.01% tends to be safe and more effective as compared to dual therapy of NB-UVB and fractional CO2 laser in non-facial vitiligo.
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Affiliation(s)
- Silada Kanokrungsee
- Skin Center, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.,Graduate School, Srinakharinwirot University, Bangkok, Thailand
| | - Saranya Khunkhet
- Skin Center, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.,Graduate School, Srinakharinwirot University, Bangkok, Thailand
| | - Salinee Rojhirunsakool
- Skin Center, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.,Graduate School, Srinakharinwirot University, Bangkok, Thailand
| | - Kamonwan Thadvibun
- Skin Center, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Thanyapat Sahaspot
- Skin Center, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
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12
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Botsali A, Caliskan E. Safety and Efficacy of High-Dose Fractional Erbium: Yttrium Aluminium Garnet Laser in Stable Vitiligo. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:600-606. [PMID: 34546107 DOI: 10.1089/photob.2021.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Evaluate the treatment outcome of vitiligo patients receiving a standard regimen of high-dose biweekly fractional 2940 nm erbium:yttrium aluminium garnet (YAG) laser applications as an add-on to various treatment modalities. Materials and methods: The authors extracted the study population's clinical images before treatment and 3rd-month control from their clinical archive and used the medical records. The primary outcome measure was 50% repigmentation at 3rd-month follow-up. Institutional ethical committee approved the study. Results: Of the evaluated 28 patients, 18 were eligible with 31 treatment regions. All patients received at least one topical agent [steroids, calcineurin inhibitors, or 5-fluorouracil (5-FU)] and 11 patients received either targeted ultraviolet B (UVB) or narrow-band UVB. Of the 31 study regions, 88.8% (8/9) of facial; 77.7% (7/9) of dorsal hand; 75% (3/4) of limb; and 25% (2/8) of finger lesions achieved 50% repigmentation at 3rd-month control. The facial and dorsal hand lesions' treatment responses were higher than finger lesions (p = 0.008 and 0.03, respectively). Upon evaluating adjuvant treatment modalities, all of the treatment regions receiving targeted UVB (n = 4) or topical 5-FU (n = 5) achieved the primary endpoint, whereas severe irritation limited the topical use of 5-FU. The most common adverse effects were mild oozing and crusting related to laser treatments. Conclusions: Even with high-energy settings, fractional erbium: YAG laser does not induce the Koebner phenomenon. Although controlled trials are required to make firm conclusions, fractional erbium: YAG laser was an effective and safe adjunctive option for stable vitiligo in a real-life setting.
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Affiliation(s)
- Aysenur Botsali
- Department of Dermatology, Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ercan Caliskan
- Department of Dermatology, Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Bakr RM, Abdel-Gaber RM, Tawfik YM. A comparative study on the use of fractional CO 2 laser with tacrolimus or calcipotriol or narrow band ultraviolet-B in treatment of stable nonsegmental vitiligo. Dermatol Ther 2020; 34:e14604. [PMID: 33249712 DOI: 10.1111/dth.14604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO2 ) laser therapy followed by narrow band ultraviolet-B (NB-UVB) phototherapy, topical tacrolimus or topical calcipotriol on stable nonsegmental vitiligo. Thirty patients with stable nonsegmental vitiligo were evaluated. All patients were subjected to three sessions of fractional CO2 laser 1 month apart. Patients were divided into three groups (each group 10 patients). Group (A) treated with tacrolimus ointment twice daily for 3 months, group (B) treated with calcipotriol ointment twice daily for 3 months, and group (C) treated with NB-UVB twice weekly for 3 months. Outcomes were evaluated by calculating vitiligo area scoring index (VASI) score change, percentage of repigmentation, patient satisfaction, and adverse effects. There was a statistical significant decrease in VASI score after treatment in the three groups. The VASI change and % of regimentation was higher in group (C) treated by laser and NB-UVB and this was significantly higher than group (B) treated with laser and calcipotriol. Otherwise, there was no statistical significant difference between other treatment groups. In concluion, NB-UVB phototherapy, topical tacrolimus, or topical calcipotriol in combination with fractional CO2 laser could be used effectively and safely as an alternative modality for treatment of vitiligo. The combination of fractional CO2 laser and NB-UVB was found to be more effective.
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Affiliation(s)
- Radwa M Bakr
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Reham M Abdel-Gaber
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Yasmin M Tawfik
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
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14
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The efficacy of fractional carbon dioxide laser combined with narrow-band ultraviolet B phototherapy for non-segmental vitiligo: a systematic review and meta-analysis. Lasers Med Sci 2020; 36:165-173. [PMID: 32572662 DOI: 10.1007/s10103-020-03069-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
Fractional carbon dioxide (CO2) laser has been used with conventional treatments for vitiligo, demonstrating more effectiveness compared with conventional treatments alone. Especially, fractional CO2 laser combined with narrow-band ultraviolet B (NB-UVB) was shown to induce more improvement compared with NB-UVB monotherapy for treating stable non-segmental vitiligo. However, the effectiveness of fractional CO2 laser plus NB-UVB for the treatment of non-segmental vitiligo remains controversial. Therefore, this study aimed to confirm the safety and efficacy of fractional CO2 laser combined with NB-UVB compared with NB-UVB monotherapy in stable non-segmental vitiligo. We searched the data from different databases, including Cochrane, Embase, and PubMed up to January 2020. Four randomized controlled trials (RCTs) for comparison between fractional CO2 laser plus NB-UVB and NB-UVB monotherapy in patients with stable non-segmental vitiligo were included. We performed meta-analyses for repigmentation improvement and patient satisfaction as well as subgroup analyses based on acral or non-acral vitiligo, according to the PRISMA guidelines. The combination treatment showed more superior results than NB-UVB monotherapy (≥ 75% repigmentation, RR 4.60, 95% CI 1.19-17.74; ≥ 50% repigmentation, RR 2.24, 95% CI 0.45-11.17; < 25% repigmentation, RR 0.81, 95% CI 0.60-1.08). Also, fractional CO2 laser plus NB-UVB significantly improved acral and non-acral vitiligo compared with NB-UVB monotherapy (standard mean difference (SMD) 1.24, 95% CI 0.66-1.82; SMD 1.14, 95% CI 0.67-1.60, respectively), while it increased markedly patient satisfaction compared with NB-UVB monotherapy (SMD 1.12, 95% CI 0.66-1.58). Collectively, this meta-analysis suggested that fractional CO2 laser combined with NB-UVB might be more effective for treating non-segmental vitiligo than NB-UVB monotherapy.
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Huang C, Li P, Wang B, Deng Y, Li J, Mao M, Jian D. Multi‐Factors Associated With Efficacy and Adverse Events of Fractional Erbium:YAG Laser‐Assisted Delivery of Topical Betamethasone for Stable Vitiligo: A Retrospective Analysis. Lasers Surg Med 2019; 52:590-596. [PMID: 31820470 DOI: 10.1002/lsm.23198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Chuchu Huang
- Department of Dermatology, National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South University87 Xiangya Road Changsha Hunan 410008 China
| | - Peiyao Li
- Department of Dermatology, National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South University87 Xiangya Road Changsha Hunan 410008 China
| | - Ben Wang
- Department of Dermatology, National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South University87 Xiangya Road Changsha Hunan 410008 China
| | - Yuxuan Deng
- Department of Dermatology, National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South University87 Xiangya Road Changsha Hunan 410008 China
| | - Ji Li
- Department of Dermatology, National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South University87 Xiangya Road Changsha Hunan 410008 China
| | - Mengping Mao
- Department of Dermatology, National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South University87 Xiangya Road Changsha Hunan 410008 China
| | - Dan Jian
- Department of Dermatology, National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South University87 Xiangya Road Changsha Hunan 410008 China
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16
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del Río-Sancho S, Castro-López V, Alonso MJ. Enhancing cutaneous delivery with laser technology: Almost there, but not yet. J Control Release 2019; 315:150-165. [DOI: 10.1016/j.jconrel.2019.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022]
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17
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Ghasemloo S, Gauthier Y, Ghalamkarpour F. Evaluation of using fractional CO 2 laser plus NB-UVB versus NB-UVB alone in inducing marginal repigmentation of vitiligo lesions. J DERMATOL TREAT 2019; 30:697-700. [PMID: 30592235 DOI: 10.1080/09546634.2018.1564232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Vitiligo is a common depigmenting skin disorder, characterized by patchy loss of skin color and finding effective treatment has remained a challenging issue. Methods: A paired (half-body) randomized clinical trial study was done to compare the efficacy and the safety of narrowband ultraviolet B (NB-UVB) plus fractional CO2 versus NB-UVB alone in stimulation of marginal repigmentation of vitiliginous patches. One side of the body was randomly treated with a fractional CO2 laser and NB-UVB twice weekly, while the other side was exposed only to NB-UVB with the same manner. Results: Thirty patients with the nonsegmental stable vitiligo and mean age of 43 ± 15 years completed a 16-week treatment period with NB-UVB on one side of the body and fractional CO2 laser therapy with NB-UBV on the other side. In addition to the higher rate of response in the combination side compared to the monotherapy side of the body (p < .001), repigmentation was greater in the combination side rather than the NB-UVB monotherapy side (p = .002). In the combination treated side, marginal repigmentation pattern was more frequently seen than perifollicular pattern (p < .001) and more frequently than monotherapy side (p < .001). Conclusion: The fractional CO2 laser combined with NB-UVB seems to be a more effective therapeutic option for treatment than NB-UVB alone for inducing marginal repigmentation.
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Affiliation(s)
- Sara Ghasemloo
- a Skin Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Yvon Gauthier
- b Vitiligo and Melasma Research Association , Bordeaux , France
| | - Fariba Ghalamkarpour
- a Skin Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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18
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Kadry M, Tawfik A, Abdallah N, Badawi A, Shokeir H. Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study. Clin Cosmet Investig Dermatol 2018; 11:551-559. [PMID: 30510437 PMCID: PMC6231433 DOI: 10.2147/ccid.s178817] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose The aim of this study was to assess the efficacy of platelet-rich plasma (PRP) vs combined fractional CO2 (Fr: CO2) laser with PRP in the treatment of stable nonsegmental vitiligo (NSV) lesions. Patients and methods This prospective, randomized, intrapatient, comparative controlled study was conducted between June 2014 and June 2016 at National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt. Thirty NSV patients were treated with PRP, Fr: CO2 laser, and combined Fr: CO2 laser with PRP. Intrapatient lesions were divide randomly into four groups. Each group was treated by one modality. The fourth group served as a control.Patients received six treatment sessions with 2-week interval for 3 months and were followed up after 3 months. Results A highly significant reduction was demonstrated through vitiligo analysis by computer-assisted grid (VACAG) in the combined Fr: CO2 laser with PRP and in the PRP only groups than other groups. These results were confirmed by mean improvement score by physician (MISP) and by VAS with no statistical difference between them. The combined Fr: CO2 laser with PRP group showed minimal side effects. Regardless of the modalities, better improvement was seen in the trunk than the face, extremities, and acral lesions with significant reduction in all regions. Face showed maximum response with combined Fr: CO2 laser with PRP. Trunk showed higher response with PRP. Upper limbs showed highest response with combined Fr: CO2 laser with PRP. Lower limbs showed the highest improvement with Fr: CO2 laser. Conclusion According to our study, combined Fr: CO2 laser with PRP achieved superior repigmentation than intradermal (ID) PRP. However, Fr: CO2 alone showed poor improvement. Combined ablative Fr: CO2 laser and PRP therapy followed by sun exposure could be used effectively and safely to treat refractory NSV.
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Affiliation(s)
- Mostafa Kadry
- Faculty of Medicine, Dermatology Department, Helwan University Cairo, Helwan, Egypt
| | - Abeer Tawfik
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Noha Abdallah
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Ashraf Badawi
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt, .,Department of Allergology and Dermatology, Szeged University, Hungary,
| | - Hisham Shokeir
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
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19
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Wen X, Hamblin MR, Xian Y, Li Y. A preliminary study of fractional CO 2 laser added to topical tacrolimus combined with 308 nm excimer lamp for refractory vitiligo. Dermatol Ther 2018; 32:e12747. [PMID: 30238584 DOI: 10.1111/dth.12747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/05/2018] [Accepted: 09/16/2018] [Indexed: 02/05/2023]
Abstract
Fractional CO2 laser has been proposed recently to be effective and well tolerated in patients with refractory vitiligo. In this preliminary, prospective study, 21 patients with multiple, localized, refractory, non-segmental vitiligo lesions were randomized to receive either tacrolimus ointment plus 308 nm excimer lamp (control), with or without the addition of fractional CO2 laser. There was no statistically significant improvement in the repigmentation on the laser side compared to the control side. Treatment was generally well-tolerated; only localized adverse effects were noted. Overall the triple combination therapy was not superior to tacrolimus ointment plus 308 nm excimer lamp. Treatment failure may reflect insufficient penetration of tacrolimus ointment through the holes created by fractional CO2 laser on the skin.
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Affiliation(s)
- Xiang Wen
- Department of Dermatology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| | - Yan Xian
- Department of Dermatology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yong Li
- Department of Dermatology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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20
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Liu L, Wu Y, Zhang J, Gu H, Luan Q, Qian L, Wang Y, Gao L, Wang H, Xiao B, Sun Y, Li H, Chen K, Zeng F, Li C, Gao T, Gao XH. Ablative fractional Co2 laser aided delivery of long-acting glucocorticoid in the treatment of acral vitiligo: a multicenter, prospective, self-bilateral controlled study. J DERMATOL TREAT 2018; 30:320-327. [PMID: 30081694 DOI: 10.1080/09546634.2018.1509048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ling Liu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yan Wu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People’s Hospital, Beijing, China
| | - Heng Gu
- Institute of Dermatology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Qi Luan
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Linhan Qian
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yanting Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Lin Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Hongyi Wang
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bihuan Xiao
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Sun
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Houmin Li
- Department of Dermatology, Peking University People’s Hospital, Beijing, China
| | - Kun Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Fanqin Zeng
- Department of Dermatology, Sun Yet-Sen Memorial Hospital of Sun Yet-Sen University, Guangzhou, China
| | - Chunying Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Tianwen Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, Liaoning, China
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21
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Doghaim NN, Gheida SF, El‐Tatawy RA, Mohammed Ali DA. Combination of fractional carbon dioxide laser with narrow band ultraviolet B to induce repigmentation in stable vitiligo: A comparative study. J Cosmet Dermatol 2018; 18:142-149. [DOI: 10.1111/jocd.12553] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Noha Nabil Doghaim
- Faculty of Medicine Department of Dermatology and Venereology Tanta University Tanta Egypt
| | - Shereen Farouk Gheida
- Faculty of Medicine Department of Dermatology and Venereology Tanta University Tanta Egypt
| | - Rania Ahmed El‐Tatawy
- Faculty of Medicine Department of Dermatology and Venereology Tanta University Tanta Egypt
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22
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Chen W, Zhou Y, Huang FR, Luo D, Wang DG. Preliminary study on the treatment of vitiligo with carbon dioxide fractional laser together with tacrolimus. Lasers Surg Med 2018; 50:829-836. [PMID: 29635693 DOI: 10.1002/lsm.22821] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Wei Chen
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
| | - Yuan Zhou
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
| | - Fei-ran Huang
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
| | - Dan Luo
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
| | - Da-guang Wang
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
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23
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Recent Advances in Pathogenesis and Medical Management of Vitiligo. PIGMENTARY SKIN DISORDERS 2018. [DOI: 10.1007/978-3-319-70419-7_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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24
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Abdelghani R, Ahmed NA, Darwish HM. Combined treatment with fractional carbon dioxide laser, autologous platelet-rich plasma, and narrow band ultraviolet B for vitiligo in different body sites: A prospective, randomized comparative trial. J Cosmet Dermatol 2017; 17:365-372. [DOI: 10.1111/jocd.12397] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Rania Abdelghani
- Dermatology and Venereology Department; Faculty of Medicine for Girls; Al-Azhar University; Cairo Egypt
| | - Naglaa A Ahmed
- Dermatology and Venereology Department; Faculty of Medicine for Girls; Al-Azhar University; Cairo Egypt
| | - Hanan M Darwish
- Dermatology and Venereology Department; Faculty of Medicine for Girls; Al-Azhar University; Cairo Egypt
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25
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El-Zawahry MB, Zaki NS, Wissa MY, Saleh MA. Effect of combination of fractional CO 2 laser and narrow-band ultraviolet B versus narrow-band ultraviolet B in the treatment of non-segmental vitiligo. Lasers Med Sci 2017; 32:1953-1958. [PMID: 28748302 DOI: 10.1007/s10103-017-2290-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
The present study was designed to evaluate the effect of combining fractional CO2 laser with narrow-band ultraviolet B (NB-UVB) versus NB-UVB in the treatment of non-segmental vitiligo. The study included 20 patients with non-segmental stable vitiligo. They were divided into two groups. Group I received a single session of fractional CO2 laser therapy on the right side of the body followed by NB-UVB phototherapy twice per week for 8 weeks. Group II received a second session of fractional CO2 laser therapy after 4 weeks from starting treatment with NB-UVB. The vitiligo lesions were assessed before treatment and after 8 weeks of treatment by VASI. At the end of the study period, the vitiligo area score index (VASI) in group I decreased insignificantly on both the right (-2.6%) and left (-16.4%) sides. In group II, VASI increased insignificantly on the right (+14.4%) and left (+2.5%) sides. Using Adobe Photoshop CS6 extended program to measure the area of vitiligo lesions, group I showed a decrease of -1.02 and -6.12% in the mean area percentage change of vitiligo lesions on the right and left sides, respectively. In group II the change was +9.84 and +9.13% on the right and left sides, respectively. In conclusion, combining fractional CO2 laser with NB-UVB for the treatment of non-segmental vitiligo did not show any significant advantage over treatment with NB-UVB alone. Further study of this combination for longer durations in the treatment of vitiligo is recommended.
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Affiliation(s)
| | - Naglaa Sameh Zaki
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Marwah Adly Saleh
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt. .,Department of Dermatology, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University School of Medicine, PO 11956, Cairo, Egypt.
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26
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Mohammad TF, Silpa-Archa N, Griffith JL, Lim HW, Hamzavi IH. Home phototherapy in vitiligo. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017. [DOI: 10.1111/phpp.12321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Narumol Silpa-Archa
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | | | - Henry W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
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27
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Yan R, Yuan J, Chen H, Li YH, Wu Y, Gao XH, Chen HD. Fractional Er:YAG laser assisting topical betamethasone solution in combination with NB-UVB for resistant non-segmental vitiligo. Lasers Med Sci 2017; 32:1571-1577. [DOI: 10.1007/s10103-017-2282-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/05/2017] [Indexed: 12/26/2022]
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28
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Fractional CO2 Laser Pretreatment to Autologous Hair Transplantation and Phototherapy Improves Perifollicular Repigmentation in Refractory Vitiligo: A Randomized, Prospective, Half-Lesion, Comparative Study. Dermatol Surg 2017; 42:1082-8. [PMID: 27560291 DOI: 10.1097/dss.0000000000000844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fractional CO2 laser and autologous hair transplantation are independently effective in the treatment of refractory and stable vitiligo. OBJECTIVE The authors' purpose was to evaluate the therapeutic efficacy of fractional CO2 laser pretreatment compared with autologous hair transplantation and phototherapy alone for refractory and stable vitiligo. METHODS A total of 20 patients with refractory and stable vitiligo were enrolled from our clinic. Resistant lesions randomly divided into 2 regions as follows: (1) Part A: fractional CO2 laser pretreatment followed by autologous transplantation and phototherapy, and (2) Part B: autologous transplantation and phototherapy alone. Five days after fractional CO2 laser application to Part A, both treatment regions received a transplant of scalp grafts. On Day 11, the entire lesion was exposed to narrow-band UVB phototherapy, twice a week for 12 weeks. The diameter of perifollicular repigmentation was measured monthly with a caliper. RESULTS Perifollicular repigmentation was detectable surrounding 74% of grafted hair follicles by Month 3. Furthermore, Part A demonstrated a significantly greater diameter of repigmentation with 6.6 ± 5.8 mm in Part A compared with 4.3 ± 1.8 mm in Part B (p = <.001). CONCLUSION In this study, our results demonstrate improved efficacy of autologous hair transplantation and narrow-band UVB with fractional CO2 laser pretreatment in refractory and stable vitiligo.
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29
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Cunha PR, Scabine Pessotti N, Bonati Mattos C, Salai AF. New approach in the treatment of refractory vitiligo: CO 2 laser combined with betamethasone and salicylic acid solution. Dermatol Ther 2016; 30. [PMID: 27548998 DOI: 10.1111/dth.12410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The aim of this study is to evaluate the use of fractional carbon dioxide laser (CO2 ) with betamethasone and salicylic acid solution in the treatment of patients with refractory vitiligo in hands. Each hand of the patient was randomly assigned to one of two groups: lesion treated with fractional carbon dioxide laser associated with betamethasone and salicylic acid solution administration or lesion treated only with betamethasone and salicylic acid solution. We conclude that combined treatment with fractional carbon dioxide laser and betamethasone associated with salicylic acid solution could effectively and safely be used in the treatment of refractory vitiligo.
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Affiliation(s)
| | | | | | - Ana Flavia Salai
- Dermatology Department, Jundiaí Medical School, Sao Paulo, Brazil
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Korobko IV, Lomonosov KM. A pilot comparative study of topical latanoprost and tacrolimus in combination with narrow-band ultraviolet B phototherapy and microneedling for the treatment of nonsegmental vitiligo. Dermatol Ther 2016; 29:437-441. [DOI: 10.1111/dth.12383] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Konstantin M. Lomonosov
- Department of Skin and Venereal Diseases, Therapeutic Faculty; I.M. Sechenov First Moscow State Medical University; Moscow Russia
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A comparative study of combined treatment with fractional carbon dioxide and targeted ultraviolet B phototherapy for facial vitiligo. Lasers Med Sci 2016; 31:1343-9. [DOI: 10.1007/s10103-016-1982-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
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Vachiramon V, Chaiyabutr C, Rattanaumpawan P, Kanokrungsee S. 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. Lasers Surg Med 2015; 48:197-202. [PMID: 26175036 DOI: 10.1002/lsm.22389] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/06/2022]
Abstract
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 CO2 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 CO2 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 CO2 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 CO2 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.
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Affiliation(s)
- Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chayada Chaiyabutr
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pinyo Rattanaumpawan
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Silada Kanokrungsee
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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