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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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2
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Bishnoi A, Parsad D. Phototherapy for vitiligo: A narrative review on the clinical and molecular aspects, and recent literature. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12968. [PMID: 38632705 DOI: 10.1111/phpp.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Vitiligo is characterized by depigmented patches resulting from loss of melanocytes. Phototherapy has emerged as a prominent treatment option for vitiligo, utilizing various light modalities to induce disease stability and repigmentation. AIMS AND METHODS This narrative review aims to explore the clinical applications and molecular mechanisms of phototherapy in vitiligo. RESULTS AND DISCUSSION The review evaluates existing literature on phototherapy for vitiligo, analyzing studies on hospital-based and home-based phototherapy, as well as outcomes related to stabilization and repigmentation. Narrowband ultra-violet B, that is, NBUVB remains the most commonly employed, studied and effective phototherapy modality for vitiligo. Special attention is given to assessing different types of lamps, dosimetry, published guidelines, and the utilization of targeted phototherapy modalities. Additionally, the integration of phototherapy with other treatment modalities, including its use as a depigmenting therapy in generalized/universal vitiligo, is discussed. Screening for anti-nuclear antibodies and tailoring approaches for non-photo-adapters are also examined. CONCLUSION In conclusion, this review provides a comprehensive overview of phototherapy for vitiligo treatment. It underscores the evolving landscape of phototherapy and offers insights into optimizing therapeutic outcomes and addressing the challenges ahead. By integrating clinical evidence with molecular understanding, phototherapy emerges as a valuable therapeutic option for managing vitiligo, with potential for further advancements in the field.
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Affiliation(s)
- Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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3
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Ju HJ, Bae JM. Bridging Molecular Mechanism and Clinical Practice in Vitiligo Treatment: An Updated Review. Dermatology 2024; 240:474-486. [PMID: 38417409 DOI: 10.1159/000537810] [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: 08/02/2022] [Accepted: 02/11/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Treatment of vitiligo seeks to achieve three goals: cessation of disease progression, regeneration of pigmentation, and prevention of recurrence. SUMMARY Number of nonsurgical interventions are available that suppress the autoimmune response and regenerate the melanocytes from the reservoir: phototherapy including psoralen and ultraviolet A, narrowband ultraviolet B, and 308-nm excimer and 311-nm Titanium:Sapphire lasers; topical agents including topical calcineurin inhibitors, topical corticosteroids, and topical 5-fluorouracil; and systemic agents including corticosteorids, mycophenolate mofetil, cyclosporine, methotrexate, minocycline, afamelanotide, and antioxidants. In recent years, a great advance has been made in the understanding of pathogenesis of vitiligo, and JAK inhibitors are being investigated as a new treatment. Minimally invasive procedures such as fractional lasers or microneedling can help achieve the optimal treatment outcome when used properly. KEY MESSAGES Our review describes various treatment modalities for vitiligo based on their molecular mechanism of action. Bridging the gap between molecular mechanisms and therapeutic options would be a valuable reference for physicians in clinical practice.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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4
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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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5
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Omar SS, Elmulla KF, Aly RG, Elkaffas A, Ismail A. A triple combination of latanoprost, fractional CO 2 laser, and platelet-rich plasma in localized vitiligo: A clinical and histopathologic study. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12944. [PMID: 38288773 DOI: 10.1111/phpp.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Several treatment modalities are available for the treatment of vitiligo due to the lack of a uniformly effective therapy. Topical latanoprost 0.005% is an effective topical treatment. Fractional CO2 laser alone or combined with platelet-rich plasma (PRP) has been proposed as effective adjunctive therapies. OBJECTIVES We aimed to compare the efficacy of topical latanoprost 0.005% (Ioprost®, Orchidia, Egypt) combined with either add-on fractional CO2 laser or fractional CO2 -PRP versus topical latanoprost monotherapy in the treatment of localized stable vitiligo. PATIENTS/METHODS The study included 60 patients randomly assigned into three equal groups. Group A patients received topical latanoprost drops only. Group B patients received topical latanoprost drops and fractional CO2 laser sessions at 2-week interval for 3 months. Group C patients received topical latanoprost drops and fractional CO2 laser sessions combined with PRP at a 2-week interval for 3 months. The mean improvement score by the physician was calculated 4 months after the start of the study. Punch skin biopsies were obtained before treatment and 4 months from the beginning of the study and stained with H&E and HMB-45 antibody for evaluation of pigmentation. RESULTS Significant clinical improvement of vitiligo lesions with significant increase of re-pigmentation were reported in the three treated groups. Latanoprost in combination with fractional CO2 and PRP was associated with more significant therapeutic outcomes than either combined latanoprost and fractional CO2 or latanoprost alone. CONCLUSION Fractional CO2 laser-PRP enhances the therapeutic efficacy of latanoprost 0.005% in the treatment of localized stable vitiligo.
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Affiliation(s)
- Salma Samir Omar
- Department of Dermatology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Khaled Fawzy Elmulla
- Department of Dermatology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rania Gaber Aly
- Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Aliaa Ismail
- Department of Dermatology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Zhu B, Liu C, Zhang L, Wang J, Chen M, Wei Y. Comparison of NB-UVB combination therapy regimens for vitiligo: A systematic review and network meta-analysis. J Cosmet Dermatol 2023; 22:1083-1098. [PMID: 36456176 DOI: 10.1111/jocd.15534] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Vitiligo was an autoimmune disease and some guidelines for the management of vitiligo encouraged the use of NB-UVB combination therapies to enhance repigmentation. OBJECTIVES To compare the effectiveness of current NB-UVB combination regimen at the improvement in repigmentation through a systematic review and network meta-analysis. METHODS We searched the electronic databases for randomized controlled trials related to NB-UVB combination therapy for vitiligo till October 2022. STATA15.0 software was applied to carrying out data analysis. RESULTS A total of 28 eligible studies involving 1194 participants were enrolled in the analysis. The NMA results revealed that compared with NB-UVB, carboxytherapy [OR = 32.35, 95% CI (1.79, 586.05)], Er: YAG laser+ topical 5% 5-FU [OR = 10.74, 95% CI (4.05, 28.49)], needling/micro-needling [OR = 3.42, 95% CI (1.18, 9.88)], betamethasone intramuscular injection [OR = 3.08, 95% CI (1.17, 8.13)], topical tacrolimus [OR = 2.54, 95% CI (1.30, 4.94)], and oral Chinese herbal medicine compound [OR = 2.51, 95% CI (1.40, 4.50)] integrated with NB-UVB were more efficacious in excellent to complete repigmentation response rate (≥75%). Besides, NB-UVB+ Er: YAG laser+ topical 5% 5-FU [OR = 0.17, 95% CI (0.04, 0.67)] and NB-UVB+ needling/micro-needling [OR = 0.24, 95% CI (0.06, 0.88)] were less likely evaluated as ineffective repigmentation response (≤25%). CONCLUSIONS All combination therapies ranked higher than NB-UVB monotherapy in inducing successful repigmentation and avoiding failed treatment in patients with vitiligo. Comprehensive consideration, NB-UVB+ Er: YAG laser+ topical 5% 5-FU and NB-UVB+ needling/microneedling would be the preferred therapeutic approaches.
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Affiliation(s)
- Baohua Zhu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Lan Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jun Wang
- Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Mingling Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuegang Wei
- Nanjing University of Chinese Medicine, Nanjing, China
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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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8
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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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Helou J, Soutou B. Eight-year sustained efficacy and safety of fractional CO 2 laser combined with sun exposure in resistant nonsegmental vitiligo: Case report. J Cosmet Dermatol 2022; 21:6518-6520. [PMID: 35980675 DOI: 10.1111/jocd.15315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 12/27/2022]
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
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10
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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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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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12
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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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13
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Utilization of Our Toolkit: A Systematic Review and Meta-analysis of Surgical Therapies in Vitiligo Treatment. Dermatol Surg 2022; 48:815-821. [DOI: 10.1097/dss.0000000000003503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Post NF, Ezekwe N, Narayan VS, Bekkenk MW, Van Geel N, Hamzavi I, Passeron T, Wolkerstorfer A. The use of lasers in vitiligo, an overview. J Eur Acad Dermatol Venereol 2022; 36:779-789. [PMID: 35176186 PMCID: PMC9314124 DOI: 10.1111/jdv.18005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/10/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- N F Post
- Department of dermatology, Amsterdam University Medical Centers, The Netherlands
| | - N Ezekwe
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - V S Narayan
- Department of dermatology, Amsterdam University Medical Centers, The Netherlands
| | - M W Bekkenk
- Department of dermatology, Amsterdam University Medical Centers, The Netherlands
| | - N Van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - I Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - T Passeron
- Department of Dermatology and INSERM U1065, University Hospital of Nice, France
| | - A Wolkerstorfer
- Department of dermatology, Amsterdam University Medical Centers, The Netherlands
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15
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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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16
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Deepadarshan K, Harish MR, Shashikumar BM, Chandran P. Efficacy and safety of 10,600 nm fractional carbon dioxide laser versus 88% phenol in treatment of idiopathic guttate hypomelanosis: A prospective study. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2022. [DOI: 10.4103/jdds.jdds_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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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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18
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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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19
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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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20
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Fractional CO2 laser, platelet rich plasma and narrow band ultraviolet B in the treatment of Vitiligo (A randomized clinical trial). Lasers Med Sci 2020; 36:1479-1486. [PMID: 33236202 DOI: 10.1007/s10103-020-03195-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
Vitiligo is a chronic acquired disease. Various therapeutic strategies are available but with variable degrees of success. Fractional CO2 laser is claimed to be effective in the treatment of refractory non-segmental vitiligo. Platelet-rich plasma may help in stimulation of the proliferation of melanocytes and repigmentation within vitiliginous patches.Our aim was to evaluate and compare the efficacy and safety of fractional CO2 laser, PRP, and NB-UVB either alone or in combination in the treatment of vitiligo. This self-controlled randomized clinical trial included 20 patients with at least 6 patches of vitiligo (VIDA score 1 and 0). Each patch was randomly assigned to receive either, fractional CO2 laser, PRP, combined fractional CO2 with PRP, combined fractional CO2 with NB-UVB, combined fractional CO2 with PRP and NB-UVB or left as a control. There was a statistically significant improvement in all treatment groups on comparing the surface area of vitiligo patches before and after treatment. However on comparing the percentage of reduction in surface area in different treatment groups, there was no statistically significant difference (P = 0.122). Fr: CO2 laser and PRP may be adjuvant therapeutic options to NB-UVB especially in the treatment of refractory cases of non-segmental vitiligo.
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21
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Ibrahim NA, Abdel Fadeel DA, Sadek A, Fadel M, Tawfik A. Intralesional vitamin D3 versus new topical photodynamic therapy in recalcitrant palmoplanter warts Randomized comparative controlled study. Photodiagnosis Photodyn Ther 2020; 32:101979. [PMID: 32866634 DOI: 10.1016/j.pdpdt.2020.101979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recalcitrant palmoplanter warts represent a therapeutic challenge. Side effects of local destructive methods necessitates the need for other less morbid modalities. Recently immunotherapy as well as light based devices and lasers have emerged as therapeutic approaches. AIM OF THE STUDY To compare between the safety and efficacy of intralesional vitamin D3 injection and photodynamic therapy (PDT) using eosin in treatment of recalcitrant palmoplanter warts. PATIENTS AND METHODS Prospective, randomized, controlled comparative study. Fifty -six patients with recalcitrant palmoplanter warts were randomly divided into 3 groups. Group A was injected with intralesional vitamin D3. Group B was subjected to PDT using eosin loaded in trasferosomes as a photosensitizer. Group C is the control group. Clinical improvement was assessed by photographic records and dermoscopic assessment, at baseline, before each session and after completion of treatment. Patients were followed up for 6 months after cure to detect recurrence. RESULTS Group A and B showed complete clearance in 88.89 % and 86.36 % respectively compared to 18.75 % in the control group. These results were statistically significant (P value<0.001). No side effects were reported except for pain during injection in group A. CONCLUSION In the current study, both vitamin D3 and PDT using Eosin are safe, highly effective and well tolerated modalities in treatment of viral warts.
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Affiliation(s)
- Nahla A Ibrahim
- General Institute of Health Insurance Hospitals, Dermatology Unit, Nasr City Hospital, Cairo, Egypt
| | - Doaa A Abdel Fadeel
- A Pharmaceutical Technology Unit, Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences, Cairo University, Egypt
| | | | - Maha Fadel
- A Pharmaceutical Technology Unit, Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences, Cairo University, Egypt
| | - Abeer Tawfik
- Dermatology unit, Department of Medical Applications of Lasers (MAL), National institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
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22
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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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23
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Chang HC, Lin MH, Tsai HH. Efficacy of Combination Therapy With Fractional Carbon Dioxide Laser and Ultraviolet B Phototherapy for Vitiligo: A Systematic Review and Meta-Analysis. Aesthet Surg J 2020; 40:NP46-NP50. [PMID: 31605101 DOI: 10.1093/asj/sjz250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hua-Ching Chang
- Drs Chang, Lin, and Tsai are Fellows at the Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ming-Hsiu Lin
- Drs Chang, Lin, and Tsai are Fellows at the Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
- Drs Lin and Tsai are Fellows at the Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiou-Hsin Tsai
- Drs Chang, Lin, and Tsai are Fellows at the Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
- Drs Lin and Tsai are Fellows at the Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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24
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No Additional Benefit of Combining Fractional Carbon Dioxide Laser With Narrow-Band Ultraviolet B Phototherapy for Vitiligo. Dermatol Surg 2019; 45:1627-1634. [DOI: 10.1097/dss.0000000000001890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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King YA, Tsai TY, Tsai HH, Huang YC. Wirksamkeit einer ablationsbasierten Kombinationstherapie bei Vitiligo: Eine systematische Übersichtsarbeit und Metaanalyse. J Dtsch Dermatol Ges 2019; 16:1197-1210. [PMID: 30300497 DOI: 10.1111/ddg.13657_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Yih-An King
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tsung-Yu Tsai
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiou-Hsin Tsai
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu-Chen Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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26
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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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27
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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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28
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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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29
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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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30
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King YA, Tsai TY, Tsai HH, Huang YC. The efficacy of ablation-based combination therapy for vitiligo: A systematic review and meta-analysis. J Dtsch Dermatol Ges 2018; 16:1197-1208. [DOI: 10.1111/ddg.13657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/19/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Yih-An King
- Department of Dermatology; Taipei Medical University Hospital; Taipei Taiwan
| | - Tsung-Yu Tsai
- Department of Dermatology; Wan Fang Hospital, Taipei Medical University; Taipei Taiwan
| | - Hsiou-Hsin Tsai
- Department of Dermatology; Taipei Medical University Hospital; Taipei Taiwan
| | - Yu-Chen Huang
- Department of Dermatology; Wan Fang Hospital, Taipei Medical University; Taipei Taiwan
- Department of Dermatology, School of Medicine, College of Medicine; Taipei Medical University; Taipei Taiwan
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31
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Chiu YJ, Perng CK, Ma H. Fractional CO 2 laser contributes to the treatment of non-segmental vitiligo as an adjunct therapy: a systemic review and meta-analysis. Lasers Med Sci 2018; 33:1549-1556. [PMID: 29696444 DOI: 10.1007/s10103-018-2516-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
The treatment of stable non-segmental vitiligo is often challenging, which new therapies are being searched. Multiple clinical trials have proposed the benefits and safety of using fractional carbon dioxide (CO2) laser as an adjunct therapy to conventional treatments. This study aimed to evaluate the safety and efficacy of fractional carbon dioxide laser as a combination therapy to conventional treatments in patients with stable non-segmental vitiligo. A literature search using PubMed, EMBASE, and the Cochrane Library was performed for comparative studies among vitiligo patients treated with additional fractional CO2 laser. Clinical outcomes in the selected studies were compared, and a meta-analysis was performed via Review Manager version 5.3, according to the PRISMA guidelines. Six studies with a total of 184 patches/patients were included in the present meta-analysis. The combination therapy group had significantly superior results than that of the control group (≥ 75% re-pigmentation, risk ratio [RR] 2.80, 95% confidence interval [CI] 1.29-6.07; ≥ 50% re-pigmentation, RR 2.26, 95% CI 1.23-5.9; < 25% re-pigmentation, RR 0.57, 95% CI 0.43-0.75). Limitations of the study included the small number of studies and sample size, inadequate blinding of participants, and variation between therapy protocols. Meta-analysis revealed that using fractional CO2 laser in combination with conventional treatments is efficient and safe, and may be considered as an adjunct therapeutic option for patients with refractive non-segmental vitiligo.
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Affiliation(s)
- Yu-Jen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, 11217, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, 11217, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, 11217, Taiwan.
- Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan.
- Department of Surgery, National Defense Medical Center, Taipei, Taiwan.
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32
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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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33
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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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34
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Koh WS, Kim JE, Ro YS, Ko JY. Comparative study of ablative fractional photothermolysis versus topical retinoid cream in the treatment of idiopathic guttate hypomelanosis. J COSMET LASER THER 2018; 20:405-409. [DOI: 10.1080/14764172.2018.1444771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Won Seon Koh
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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35
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Autologous cell suspension grafting in segmental vitiligo and piebaldism: a randomized controlled trial comparing full surface and fractional CO
2
laser recipient‐site preparations. Br J Dermatol 2017; 177:1293-1298. [DOI: 10.1111/bjd.15569] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2017] [Indexed: 11/26/2022]
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36
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Esmat S, Hegazy RA, Shalaby S, Hu SCS, Lan CCE. Phototherapy and Combination Therapies for Vitiligo. Dermatol Clin 2017; 35:171-192. [PMID: 28317527 DOI: 10.1016/j.det.2016.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vitiligo is a disease characterized by disappearance of melanocytes from the skin. It can negatively influence the physical appearance of affected individuals, and may profoundly affect a person's psychosocial function and quality of life. Therefore, vitiligo should not be considered as merely a condition that affects a patient's appearance, but needs to be actively treated in patients who seek medical help. Phototherapy has been used as the main treatment modality for patients with vitiligo. Different forms of phototherapy for vitiligo include broadband UVB, narrowband UVB, excimer light and excimer laser, and psoralen plus UVA.
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Affiliation(s)
- Samia Esmat
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Rehab A Hegazy
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Suzan Shalaby
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
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37
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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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38
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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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39
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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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40
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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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41
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El Mofty M, Esmat S, Hunter N, Mashaly HM, Dorgham D, Shaker O, Ibrahim S. Effect of different types of therapeutic trauma on vitiligo lesions. Dermatol Ther 2016; 30. [PMID: 27998025 DOI: 10.1111/dth.12447] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/13/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022]
Abstract
New treatment modalities for vitiligo acting by changing certain cytokines and metalloproteinases are newly emerging. The aim of this work is to To assess the efficacy of trichloroacetic acid (TCA) chemical peel, dermapen, and fractional CO2 laser in treatment of stable non-segmental vitiligo and to detect their effects on IL-17 and MMP-9 levels. Thirty patients with stable vitiligo were recruited in a randomized controlled study. They were randomly categorized into three equal groups. Group 1: TCA peel, Group 2: dermapen machine, and Group 3: Fractional CO2 laser. Skin biopsies were taken from treated areas and from control areas for which MMP-9 and IL-17 tissue levels were measured using ELISA. The 30 vitiligo patients had low basal tissue MMP-9 levels and high baseline IL-17 tissue levels. As regards the three different used modalities, all of them caused rise in MMP-9 as well as IL-17 levels and almost their levels were much more elevated with repetition of the previously mentioned traumatic procedures. TCA 25% peel proved to be the most effective modality both clinically and laboratory and it can be used prior or with other conventional therapies in the treatment of vitiligo.
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Affiliation(s)
- Medhat El Mofty
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Esmat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nahla Hunter
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba M Mashaly
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Dorgham
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Olfat Shaker
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sarah Ibrahim
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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42
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Abstract
Vitiligo, an acquired depigmentation disorder, manifests as white macules on the skin and can cause significant psychological stress and stigmatization. Recent advances have shed light on key components that drive disease onset and progression as well as therapeutic approaches. Vitiligo can be triggered by stress to the melanin pigment-producing cells of the skin, the melanocytes. The triggers, which range from sunburn to mechanical trauma and chemical exposures, ultimately cause an autoimmune response that targets melanocytes, driving progressive skin depigmentation. The most significant progress in our understanding of disease etiology has been made on three fronts: (1) identifying cellular responses to stress, including antioxidant pathways and the unfolded protein response (UPR), as key players in disease onset, (2) characterizing immune responses that target melanocytes and drive disease progression, and (3) identifying major susceptibility genes. The current model for vitiligo pathogenesis postulates that oxidative stress causes cellular disruptions, including interruption of protein maturation in the endoplasmic reticulum (ER), leading to the activation of the UPR and expression of UPR-regulated chemokines such as interleukin 6 (IL-6) and IL-8. These chemokines recruit immune components to the skin, causing melanocytes to be targeted for destruction. Oxidative stress can further increase melanocyte targeting by promoting antigen presentation. Two key components of the autoimmune response that promote disease progression are the interferon (IFN)-γ/CXCL10 axis and IL-17-mediated responses. Several genome-wide association studies support a role for these pathways, with the antioxidant gene
NRF2, UPR gene
XBP1, and numerous immune-related genes including class I and class II major histocompatibility genes associated with a risk for developing vitiligo. Novel approaches to promote repigmentation in vitiligo are being investigated and may yield effective, long-lasting therapies.
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Affiliation(s)
- Prashiela Manga
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, 10016, USA
| | - Nada Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, 10016, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, 10016, USA
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43
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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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44
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Chitvanich S, Rerknimitr P, Panchaprateep R, Pongprutthipan M, Asawanonda P. Combination of non-ablative fractional photothermolysis and 0.1% tacrolimus ointment is efficacious for treating idiopathic guttate hypomelanosis. J DERMATOL TREAT 2016; 27:456-60. [DOI: 10.3109/09546634.2015.1133883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Sokolova A, Lee A, D Smith S. The Safety and Efficacy of Narrow Band Ultraviolet B Treatment in Dermatology: A Review. Am J Clin Dermatol 2015; 16:501-31. [PMID: 26369540 DOI: 10.1007/s40257-015-0151-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Narrow-band ultraviolet B (NBUVB) phototherapy is an important treatment modality in dermatology. The most common dermatological indications for NBUVB include psoriasis, atopic dermatitis and vitiligo; however, it has been found to be an effective and well-tolerated treatment option in various other dermatoses. The efficacy of NBUVB phototherapy compares favorably with other available photo(chemo)therapy options and its efficacy is further augmented by a number of topical and systemic adjuncts. The long-term safety of NBUVB phototherapy remains to be fully elucidated; however, available data now suggest that it is safe and well-tolerated. The objective of this review was to summarize the current understanding of the safety and efficacy of NBUVB phototherapy in dermatology.
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Affiliation(s)
- Anna Sokolova
- Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
| | - Andrew Lee
- Department of Dermatology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.
| | - Saxon D Smith
- Department of Dermatology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
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46
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47
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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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Li L, Wu Y, Li L, Sun Y, Qiu L, Gao XH, Chen HD. Triple combination treatment with fractional CO2 laser plus topical betamethasone solution and narrowband ultraviolet B for refractory vitiligo: a prospective, randomized half-body, comparative study. Dermatol Ther 2015; 28:131-4. [PMID: 25753514 DOI: 10.1111/dth.12202] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Vitiligo on extremities and/or bony prominences is very resistant to treatment. Twenty-five patients with symmetrical and stable vitiligo on extremities and/or bony prominences were enrolled. The treatment side received fractional carbon dioxide laser followed by topical compound betamethasone solution and narrowband ultraviolet B phototherapy. The control side received laser treatment plus phototherapy. The result of treatment side showed that 44% patients achieved over 50% re-pigmentation and patient satisfaction score was 5.12 ± 3.23, higher than those of control (p < 0.05). Adverse events were slight and tolerable. The triple combination treatment could be used as an alternative modality for refractory vitiligo.
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Affiliation(s)
- Lu Li
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Yan Wu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Li Li
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Yan Sun
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Li Qiu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Hong-Duo Chen
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
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Whitton ME, Pinart M, Batchelor J, Leonardi-Bee J, González U, Jiyad Z, Eleftheriadou V, Ezzedine K. Interventions for vitiligo. Cochrane Database Syst Rev 2015; 2015:CD003263. [PMID: 25710794 PMCID: PMC10887429 DOI: 10.1002/14651858.cd003263.pub5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vitiligo is a chronic skin disorder characterised by patchy loss of skin colour. Some people experience itching before the appearance of a new patch. It affects people of any age or ethnicity, more than half of whom develop it before the age of 20 years. There are two main types: generalised vitiligo, the common symmetrical form, and segmental, affecting only one side of the body. Around 1% of the world's population has vitiligo, a disease causing white patches on the skin. Several treatments are available. Some can restore pigment but none can cure the disease. OBJECTIVES To assess the effects of all therapeutic interventions used in the management of vitiligo. SEARCH METHODS We updated our searches of the following databases to October 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 10), MEDLINE, Embase, AMED, PsycINFO, CINAHL and LILACS. We also searched five trials databases, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA Randomised controlled trials (RCTs) assessing the effects of treatments for vitiligo. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed study eligibility and methodological quality, and extracted data. MAIN RESULTS This update of the 2010 review includes 96 studies, 57 from the previous update and 39 new studies, totalling 4512 participants. Most of the studies, covering a wide range of interventions, had fewer than 50 participants. All of the studies assessed repigmentation, however only five reported on all of our three primary outcomes which were quality of life, > 75% repigmentation and adverse effects. Of our secondary outcomes, six studies measured cessation of spread but none assessed long-term permanence of repigmentation resulting from treatment at two years follow-up.Most of the studies assessed combination therapies which generally reported better results. New interventions include seven new surgical interventions.We analysed the data from 25 studies which assessed our primary outcomes. We used the effect measures risk ratio (RR), and odds ratio (OR) with their 95% confidence intervals (CI) and where N is the number of participants in the study.We were only able to analyse one of nine studies assessing quality of life and this showed no statistically significant improvement between the comparators.Nine analyses from eight studies reported >75% repigmentation. In the following studies the repigmentation was better in the combination therapy group: calcipotriol plus PUVA (psoralen with UVA light) versus PUVA (paired OR 4.25, 95% CI 1.43 to 12.64, one study, N = 27); hydrocortisone-17-butyrate plus excimer laser versus excimer laser alone (RR 2.57, 95% CI 1.20 to 5.50, one study, N = 84); oral minipulse of prednisolone (OMP) plus NB-UVB (narrowband UVB) versus OMP alone (RR 7.41, 95% CI 1.03 to 53.26, one study, N = 47); azathioprine with PUVA versus PUVA alone (RR 17.77, 95% CI 1.08 to 291.82, one study, N = 58) and 8-Methoxypsoralen (8-MOP ) plus sunlight versus psoralen (RR 2.50, 95% CI 1.06 to 5.91, one study, N = 168). In these three studies ginkgo biloba was better than placebo (RR 4.40, 95% CI 1.08 to 17.95, one study, N = 47); clobetasol propionate was better than PUVAsol (PUVA with sunlight) (RR 4.70, 95% CI 1.14 to 19.39, one study, N = 45); split skin grafts with PUVAsol was better than minipunch grafts with PUVAsol (RR 1.89, 95% CI 1.25 to 2.85, one study, N = 64).We performed one meta-analysis of three studies, in which we found a non-significant 60% increase in the proportion of participants achieving >75% repigmentation in favour of NB-UVB compared to PUVA (RR 1.60, 95% CI 0.74 to 3.45; I² = 0%).Studies assessing topical preparations, in particular topical corticosteroids, reported most adverse effects. However, in combination studies it was difficult to ascertain which treatment caused these effects. We performed two analyses from a pooled analysis of three studies on adverse effects. Where NB-UVB was compared to PUVA, the NB-UVB group reported less observations of nausea in three studies (RR 0.13, 95% CI 0.02 to 0.69; I² = 0% three studies, N = 156) and erythema in two studies (RR 0.73, 95% CI 0.55 to 0.98; I² = 0%, two studies, N = 106), but not itching in two studies (RR 0.57, 95% CI 0.20 to 1.60; I² = 0%, two studies, N = 106).Very few studies only assessed children or included segmental vitiligo. We found one study of psychological interventions but we could not include the outcomes in our statistical analyses. We found no studies evaluating micropigmentation, depigmentation, or cosmetic camouflage. AUTHORS' CONCLUSIONS This review has found some evidence from individual studies to support existing therapies for vitiligo, but the usefulness of the findings is limited by the different designs and outcome measurements and lack of quality of life measures. There is a need for follow-up studies to assess permanence of repigmentation as well as high- quality randomised trials using standardised measures and which also address quality of life.
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Affiliation(s)
- Maxine E Whitton
- c/o Cochrane Skin Group, The University of Nottingham, Room A103, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR. .
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Rerknimitr P, Chitvanich S, Pongprutthipan M, Panchaprateep R, Asawanonda P. Non-ablative fractional photothermolysis in treatment of idiopathic guttate hypomelanosis. J Eur Acad Dermatol Venereol 2014; 29:2238-42. [DOI: 10.1111/jdv.12763] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
- P. Rerknimitr
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- Dermatology Unit; Department of Medicine; King Chulalongkorn Memorial Hospital; Thai Red Cross Society; Bangkok Thailand
| | - S. Chitvanich
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- Dermatology Unit; Department of Medicine; King Chulalongkorn Memorial Hospital; Thai Red Cross Society; Bangkok Thailand
| | - M. Pongprutthipan
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - R. Panchaprateep
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- Dermatology Unit; Department of Medicine; King Chulalongkorn Memorial Hospital; Thai Red Cross Society; Bangkok Thailand
| | - P. Asawanonda
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
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