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Effects of a preceding fractional carbon dioxide laser on the outcome of combined local narrowband ultraviolet B and topical steroids in patients with vitiligo in difficult-to-treat areas.
Lasers Surg Med. 2016 Feb; 48(2):197-202.LS

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.

Authors+Show Affiliations

Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

26175036

Citation

Vachiramon, Vasanop, et al. "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 in Surgery and Medicine, vol. 48, no. 2, 2016, pp. 197-202.
Vachiramon V, Chaiyabutr C, Rattanaumpawan P, et al. 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. 2016;48(2):197-202.
Vachiramon, V., Chaiyabutr, C., Rattanaumpawan, P., & Kanokrungsee, S. (2016). 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 in Surgery and Medicine, 48(2), 197-202. https://doi.org/10.1002/lsm.22389
Vachiramon V, et al. 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. 2016;48(2):197-202. PubMed PMID: 26175036.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Vachiramon,Vasanop, AU - Chaiyabutr,Chayada, AU - Rattanaumpawan,Pinyo, AU - Kanokrungsee,Silada, Y1 - 2015/07/14/ PY - 2015/06/15/accepted PY - 2015/7/16/entrez PY - 2015/7/16/pubmed PY - 2016/12/20/medline KW - fractional laser KW - laser KW - narrowband ultraviolet B KW - phototherapy KW - vitiligo SP - 197 EP - 202 JF - Lasers in surgery and medicine JO - Lasers Surg Med VL - 48 IS - 2 N2 - 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. SN - 1096-9101 UR - https://www.unboundmedicine.com/medline/citation/26175036/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_ DB - PRIME DP - Unbound Medicine ER -