Fractional Er:YAG laser assisting topical betamethasone solution in combination with NB-UVB for resistant non-segmental vitiligo

Abstract

Resistant non-segmental vitiligo is difficult to be treated. Ablative erbium-YAG (Er:YAG) laser has been used in the treatment of vitiligo, but the ablation of entire epidermis frustrated the compliance of patients. The purpose of this study is to investigate the effects of fractional Er:YAG laser followed by topical betamethasone and narrow band ultraviolet B (NB-UVB) therapy in the treatment of resistant nonsegmental vitiligo. The vitiligo lesions of each enrolled patient were divided into four treatment parts, which were all irradiated with NB-UVB. Three parts were, respectively, treated with low, medium, or high energy of Er:YAG laser, followed by topical betamethasone solution application. A control part was spared with laser treatment and topical betamethasone. The treatment period lasted 6 months. The efficacy was assessed by two blinded dermatologists. Treatment protocol with high energy of 1800 mJ/P of fractional Er:YAG laser followed by topical betamethasone solution and in combination with NB-UVB made 60% patients achieve marked to excellent improvement in white patches. The protocol with medium energy of 1200 mJ/P of laser assisted approximate 36% patients achieve such improvement. The two protocols, respectively, showed better efficacies than NB-UVB only protocol. However, fractional Er:YAG laser at low energy of 600 mJ/P did not provide such contributions to the treatment of vitiligo. The fractional Er:YAG laser in combination with topical betamethasone solution and NB-UVB was suitable for resistant non-segmental vitiligo. The energy of laser was preferred to be set at relatively high level.

An Innovative Therapeutic Protocol for Vitiligo: Experience with the Use of Fraxel Herbium Laser, Topical Latanoprost and Successive Irradiation with UVA - 1 Laser

“…At first, we used a Fraxel Herbium laser (Valseriana® Herbium laser) with a wavelength of 1540 nm and high energy level of 1800 mJ/P. We performed only one laser passage for each lesion to achieve micro-areas of epidermal ablation [ 6 ].…”

Treatment protocols and efficacy of combined laser with medical treatment modalities in vitiligo

“…They concluded that treatment for three months might be sufficient for induction therapy; however, continuing the treatment for another three months was suggested to preserve of response. In addition, they postulated that ER: YAG may have slower efficacy compared to CO 2 laser due to less photothermal effects; however, it has higher safety profile due to precise ablation of skin compared to CO 2 laser 40 . Similarly, another RCT demonstrated significant effective RR with triple therapy of fractional ER: YAG laser with TCS and NB‐UVB compared to NB‐UVB and TCS.…”

“…[27][28][29][30][31][32][33][34][35][36][37][38] Combined fractional ablative lasers with other medical modalities are preferable to conventional lasers due to favorable safety profile and outcome. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] ***Fractional Er:YAG usually have slower response rate with higher safety profile compared to fractional CO 2 laser. [39][40][41][42] Combination of fractional ARLs with topical therapies (including TCS, TCI, and especially 5-FU) with or without UVB therapy (NBUVB or MEL/EL) is recommended in glabrous skin or areas with sparse hairs including distal of toes and fingers, periungual, ankle, and bony prominence areas.…”

“…[39][40][41][42] Combination of fractional ARLs with topical therapies (including TCS, TCI, and especially 5-FU) with or without UVB therapy (NBUVB or MEL/EL) is recommended in glabrous skin or areas with sparse hairs including distal of toes and fingers, periungual, ankle, and bony prominence areas. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Only one study revealed superior efficacy of fractional ablative lasers in progressive phase compared to stable phase of vitiligo 35 ; thus until gathering more evidence, it is prudent to avoid laser therapy during progressive phase. Adding systemic CS in progressive phase of vitiligo to laser therapy is recommended in order to stabilize active stage of disease and stimulate repigmentation.…”

Lasers in the Treatment of Vitiligo

“…They divided four parts such as one of them is control group given NUVB and other three of them took different frequency of energy to calibrate most effective and least painful method of these modality. They found better response at the medium or high energy protocols [41]. Mohtari et al tried to find a unresponsiveness vitiligo part a new modality that is firstly used ER:YAG laser than applied clobetasol or 5-FU dressing and found better cosmetic results via ablation [42].…”