Current art of combination therapy with autologous platelet‐rich plasma for stable vitiligo: A meta‐analysis

Abstract

Presently, there is an explosion in various uses of platelet‐rich plasma (PRP). Several trials comparing combination therapy with PRP vs monotherapy for vitiligo have been published. However, evidence‐based information is not enough for making well‐informed decisions. This study aimed to evaluate several combination therapy strategies for vitiligo. EMBASE, PubMed, Web of Science, Cochrane Library and Google Scholar databases were searched to identify randomised controlled trials comparing combination therapy with PRP vs monotherapy for vitiligo. Eleven studies with 670 cases were included. Compared with monotherapy, clinical improvement of repigmentation was significantly higher in 308‐nm excimer laser combined with PRP (odds rate for response rate of 50%‐100% repigmentation, 4.47; 95% CI, 2.47‐8.10; P < .00001) and in fractional carbon dioxide laser combined with PRP (mean difference for mean improvement grades of repigmentation, 1.61; 95% CI, 0.24‐2.99; P = .02), respectively. Compared to monotherapy, there is no higher clinical improvement in strategies of PRP combined with narrowband‐ultraviolet B or non‐cultured epidermal cell suspension. Trivial adverse events were reported. This meta‐analysis summarises current evidence that PRP combined with 308‐nm excimer laser or fractional carbon dioxide laser is effective and safe for vitiligo. This systematic review and meta‐analysis aims to evaluate the effectiveness and safety of several combination therapy strategies with PRP in the treatment of vitiligo. The response rate of repigmentation and mean improvement grades of repigmentation were mainly used for qualitative assessment. PRP combined with 308‐nm excimer laser or fractional carbon dioxide laser is effective and safe for vitiligo due to its healing and regenerative properties.

Efficacy of autologous platelet‐rich plasma in the treatment of vitiligo: A 10‐patient prospective study

“… Growth factors that stimulate keratinocyte and fibroblast proliferation and improve their interaction with melanocytes to make them stable 12 . These multiple factors lead to the migration of melanocytes from peri‐lesional skin, thus allowing repigmentation 13–16 .…”

“…An intradermal injection of the PRP combined with vitamin D was indicated with good results and patients were satisfied 12 …”

Comparison between 308‐nm excimer light alone versus 308‐nm excimer light and platelet‐rich plasma in the treatment for localized vitiligo

“…3 However, the response rate of >75% repigmentation ranged between 12.5% and 61%, indicating that the efficacy of MEL alone for vitiligo might be limited. 20 The use of PRP in the treatment for vitiligo, either alone or in combination with other modalities, is relatively new. Using PRP alone in the treatment for localized stable vitiligo was non-effective 18 or resulted in only poor response (only 20% of patients achieved >75% repigmentation).…”

Meta-analysis of the efficacy of adding platelet-rich plasma to 308-nm excimer laser for patients with vitiligo

“…Multiple clinical trials investigated the effectiveness of PRP in combination with NB-UVB, 12 excimer laser, 13 fractional CO2 laser, 14 and vitamin D 15 therapy in treating vitiligo, finding that combined treatment can enhance outcomes and reduce the occurrence of adverse events. The efficacy of PRP plus 308-nm excimer laser therapy compared with 308-nm excimer laser therapy alone remains uncertain, and no quantitatively synthesized analyses have been performed.…”