Site‐oriented depigmentation in vitiligo patients using Q‐switched Nd:YAG laser (1,064/532 nm), cryotherapy and chemical peels: A comparative study

Abstract

Depigmentation emerges as a feasible solution for vitiligo universalis and refractory cases of vitiligo vulgaris that hinder patients' quality of life. A range of depigmenting modalities has previously been developed. However, each has its own limitations. Based on skin sensitivity, this study sets out to compare the efficacy and tolerability of “trichloroacetic acid (TCA) peels 25% and 50% and Qs Nd:YAG laser (1,064/532 nm)” for facial depigmentation and “cryotherapy, phenol 88% and Qs Nd:YAG (1,064/532 nm)” for extrafacial skin depigmentation. Forty vitiligo patients were examined and equally divided into facial & extrafacial groups. Regular sessions were performed. Patients' responses were assessed after 3 months or when excellent/complete depigmentation was attained through assessing “depigmentation grade”, “extent of depigmented skin”, “patient satisfaction” and “overall response”. Patients were observed for a six‐month follow‐up period. In facial depigmentation, Qs Nd:YAG showed the highest significant response followed by TCA 50% and 25%. In extrafacial depigmentation cryotherapy, phenol 88% and Qs Nd:YAG laser displayed positive outcomes without significant difference. Among the modalities tested Qs Nd:YAG yielded superior results in facial residual pigmentation in vitiligo when compared to TCA 50% and 25%, whereas in extrafacial sites Qs Nd:YAG, cryotherapy and phenol were equally effective.

Clinical and trichoscopic evaluation of trichloroacetic acid 35% vs phenol 88% peels in treatment of alopecia areata

“…No cutaneous scarring or abnormal pulse rate or rhythm detected in the current study which was consistent with earlier reports 21,24 . Furthermore, all treated patches showed remission and resolution of all side effects when examined 6 months past therapy, in agreement with Kar and Singh 8 …”

The use of trichloroacetic acid as a depigmenting therapy in universal vitiligo

“…Depigmentation with TCA 100 % had better results compared to the lower concentrations used by El‐Mofty et al. [8], who reported excellent depigmentation in 35 % of the tested subjects with TCA 25 % and 50 % with TCA 50 %. This was probably due to the use of higher concentrations.…”

“…Post inflammatory hypopigmentation is a well‐known side effect of TCA peels [8]. Chemical peels can cause both post‐inflammatory hyper‐ and hypopigmentation.…”

“…Post inflammatory hypopigmentation was also reported as a late onset complication to TCA [8]. To our knowledge, the use of TCA for depigmentation was only described in one report by El‐Mofty et al., [8] who examined the use of TCA 25 % and 50 % to remove residual, facial pigmentation in 20 Egyptian patients with universal vitiligo. The study was limited by the small sample size and the use of lower concentrations of the chemical.…”

Die Verwendung von Trichloressigsäure als Depigmentierungstherapie bei Vitiligo universalis

“…Nach unserer Kenntnis wurde TCA zur Depigmentierung lediglich in einem Bericht von El‐Mofty et al. [8] beschrieben. Dabei wurde TCA in Konzentrationen von 25 % und 50 % zur Beseitigung der fazialen Restpigmentierung bei 20 ägyptischen Patienten mit universeller Vitiligo eingesetzt.…”