Efficacy of fractional carbon dioxide laser versus 0.1% tacrolimus cream in the treatment of segmental vitiligo
Keywords:
Vitiligo, CO2 fractional laser, Repigmentation, Tacrolimus cream, Vitiligo Area Scoring IndexAbstract
Objective To compare the efficacy of fractional carbon dioxide laser versus 0.1% tacrolimus cream in the treatment of segmental vitiligo. Methods The randomized controlled trial was conducted in the Dermatology department, Lahore General Hospital Lahore for duration of 6 months (June 2018 to December 2018). Total 120 patients were recruited and divided randomly in 2 equal groups. In group A; fractional CO2 laser was applied once a month. In group B; 0.1% tacrolimus cream was applied twice a day. After 2 months, efficacy was measured i.e. >50% reduction in VASI score. SPSS v. 25 was used to analyze the collected information. Results The mean age of patients in CO2 laser group was 41.68 ± 14.26 years, there were 17 (28.3%) males and 43 (71.7%) females. In tacrolimus cream group, the mean age of patients was 38.57±12.72 years, there were 18 (26.7%) males and 44 (73.3%) females. The mean percentage reduction in VASI score was 53.98±18.06 with CO2 laser and 39.18±15.01 with tacrolimus. The difference was significant (p<0.05). Efficacy was achieved in 34 (56.7%) cases with CO2 laser and in 19 (31.7%) with tacrolimus. The difference was significant (p<0.05). Conclusion In conclusion, CO2 fractional laser was found significantly effective in re-pigmentation of vitiligo as compared to tacrolimus.References
Wong PC, Leung Y-Y, Li EK, Tam L-S. Measuring disease activity in psoriatic arthritis. Int J Rheumatol. 2012; 2012:839425.
Whitton M, Pinart M, Batchelor J, Leonardi‐Bee J, Gonzalez U, Jiyad Z, et al. Evidence‐based management of vitiligo: summary of a Cochrane systematic review. Br J Dermatol. 2016;174(5):962-9.
Krüger C, Schallreuter KU. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. Int J Dermatol. 2012;51(10):1206-12.
Taieb A, Alomar A, Böhm M, Dell’Anna M, De Pase A, Eleftheriadou V, et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2013;168(1):5-19.
Berti S, Buggiani G, Lotti T. Use of tacrolimus ointment in vitiligo alone or in combination therapy. Skin therapy letter. 2009;14(4):5-7.
Nurhudatiana A, editor A Computer-Aided Diagnosis System for Vitiligo Assessment: A Segmentation Algorithm. International Conference on Soft Computing, Intelligence Systems, and Information Technology; 2015: Springer.
Feily A. Vitiligo Extent Tensity Index (VETI) score: a new definition, assessment and treatment evaluation criteria in vitiligo. Dermatol Pract Concept. 2014;4(4):81.
Xing C, Xu A. The effect of combined calcipotriol and betamethasone dipropionate ointment in the treatment of vitiligo: an open, uncontrolled trial. J Drugs Dermatol: 2012;11(10):e52-4.
Filippini M, Del Duca E, Negosanti F, Bonciani D, Negosanti L, Sannino M, et al. Fractional CO2 laser: from skin rejuvenation to vulvo-vaginal reshaping. Photomed Laser Surg. 2017;35(3):171-5.
Helou J, Maatouk I, Obeid G, Moutran R, Stephan F, Tomb R. Fractional laser for vitiligo treated by 10 600 nm ablative fractional carbon dioxide laser followed by sun exposure. Lasers Surg Med. 2014;46(6):443-8.
Khullar G, Kanwar A, Singh S, Parsad D. Comparison of efficacy and safety profile of topical calcipotriol ointment in combination with NB‐UVB vs. NB‐UVB alone in the treatment of vitiligo: a 24‐week prospective right–left comparative clinical trial. J Eur Acad Dermatol Venereol. 2015;29(5):925-32.
Li L, Wu Y, Li L, Sun Y, Qiu L, Gao XH, et al. 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 Therapy. 2015;28(3):131-4.
Xu AE, Zhang DM, Wei XD, Huang B, Lu LJ. Efficacy and safety of tarcrolimus cream 0.1% in the treatment of vitiligo. Int J Dermatol. 2009;48(1):86-90.
Nicolaidou E, Antoniou C, Stratigos A, Katsambas AD. Narrowband ultraviolet B phototherapy and 308-nm excimer laser in the treatment of vitiligo: a review. J Am Acad Dermatol. 2009;60(3):470-7.
Kumar R, Parsad D, Kanwar A, Kaul D. Altered levels of Ets‐1 transcription factor and matrix metalloproteinases in melanocytes from patients with vitiligo. Br J Dermatol. 2011;165(2):285-91.
Lee C-H, Wu S-B, Hong C-H, Yu H-S, Wei Y-H. Molecular mechanisms of UV-induced apoptosis and its effects on skin residential cells: the implication in UV-based phototherapy. Int J Molecul Sci. 2013;14(3):6414-35.
Garg T, Chander R, Jain A. Combination of microdermabrasion and 5‐fluorouracil to induce repigmentation in vitiligo: an observational study. Dermatol Surg. 2011;37(12):1763-6.
Ibrahim ZA, El‐Ashmawy AA, El‐Tatawy RA, Sallam FA. The effect of platelet‐rich plasma on the outcome of short‐term narrowband–ultraviolet B phototherapy in the treatment of vitiligo: a pilot study. J Cosmet Dermatol. 2016;15(2):108-16.
Gandhi K, Ezzedine K, Anastassopoulos KP, Patel R, Sikirica V, Daniel SR, et al. Prevalence of Vitiligo Among Adults in the United States. JAMA Dermatol. 2022;158(1):43-50.
Jin Y, Santorico SA, Spritz RA. Pediatric to Adult Shift in Vitiligo Onset Suggests Altered Environmental Triggering. J Invest Dermatol. 2020;140(1):241-3.e4.
Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology (Basel, Switzerland). Dermatology. 2020;236(6):571-92.
Kim HJ, Hong ES, Cho SH, Lee JD, Kim HS. Fractional Carbon Dioxide Laser as an" Add-on" Treatment for Vitiligo: A Meta-analysis with Systematic Review. Acta Dermato-Venereol. 2018;98(2):459.
Yuan J, Chen H, Yan R, Cui S, Li Y-H, Wu Y, et al. Fractional CO 2 lasers contribute to the treatment of stable non-segmental vitiligo. Eur J Dermatol. 2016;26(6):592-8.
