Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study

Abstract

PurposeThe 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 methodsThis 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.ResultsA 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.ConclusionAccording 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.

<p>The Usefulness of Platelet-Rich Plasma (PRP) for the Treatment of Vitiligo: State of the Art and Review</p>

“…1,[12][13][14][15][16] In all reports, 1,[12][13][14][15][16] all treated patients showed a stable vitiligo, and a significantly higher improvement in the PRP groups was always observed compared to control groups, regardless of the combined treatment associated with PRP. 1,[12][13][14][15][16] Regarding the side effects, PRP in vitiligo patients is safe, without important and specific side effects. 1,[12][13][14][15][16] Pain at the injection site was the main side effect, although it can be avoided applying 45-60 minutes before the injection of an anesthetic cream.…”

“…1,[12][13][14][15][16] The mean time of follow-up of treated patients was 6 months (ranging between 3 and 12 months). 1,[12][13][14][15][16] In all reports, 1,[12][13][14][15][16] all treated patients showed a stable vitiligo, and a significantly higher improvement in the PRP groups was always observed compared to control groups, regardless of the combined treatment associated with PRP. 1,[12][13][14][15][16] Regarding the side effects, PRP in vitiligo patients is safe, without important and specific side effects.…”

“…1,[12][13][14][15][16] Regarding the side effects, PRP in vitiligo patients is safe, without important and specific side effects. 1,[12][13][14][15][16] Pain at the injection site was the main side effect, although it can be avoided applying 45-60 minutes before the injection of an anesthetic cream. 16 Besides, in order to avoid local superinfection, topical antibiotics can be used 3 days after injection.…”

“…16 Ecchymosis in the site of injection may occur. 14 Ejjiyar et al reported the onset of Koebner's phenomenon in a female patient phototype IV with the onset of facial non-segmental vitiligo after the third injection of PRP, for aesthetic purposes. 17…”

Harnessing the Power of Regenerative Therapy for Vitiligo and Alopecia Areata

“…In stable nonsegmental vitiligo, a prospective randomized controlled study looked at the efficacy of PRP alone or combined with fractional CO 2 laser. The lesions treated by PRP alone showed significant improvement, whereas lesions treated with fractional CO 2 laser only or with natural sunlight only did not (Kadry et al, 2018).…”