Study the effect of erbium:YAG laser plus topical 5‐flurouracil in stable vitiligo resistant to NB‐UVB phototherapy

Abstract

Background: NB-UVB phototherapy is still an effective treatment in vitiligo but requires more than 1 year for its completion. Topical 5-flurouracil could improve the proliferation and migration of melanocytes. Laser-assisted dermabrasion results in stimulation of the inactive melanocytes present at the outer root sheath of the lower portion of the hair follicle, which migrates upward until they reach the surface of the skin. Objective: To evaluate the effect of Er:YAG laser skin ablation followed by topical 5-flurouracil on the outcome of NB-UVB phototherapy as a short term technique in resistant and stable vitiligo. Methods: The current study included 40 patients suffering from bilateral stable vitiligo resistant to NB-UVB. For each patient, one side of the body subjected to 4 months NB-UVB sessions (control side). While the other side of the body subjected to one session of Er:YAG laser ablation combined with topical 5% 5-flurouracil application under occlusion followed by NB-UVB sessions for 4 months after complete re-epithelization. Outcomes were evaluated objectively based on standard digital photographs, histopathological examination, patient satisfaction, and adverse effects. Results: There was a statistically significant improvement in the repigmentation in laser side compared with control side. Histopathological examination revealed expression of prominent melanin pigmentation, with marked expression for Melan-A in laser side, whereas these findings were negative in control side. Conclusion: Er:YAG laser ablation, followed by 5FU application before NB-UVB phototherapy for vitiligo, is a safe and tolerable technique that improves the outcome of short-term NB-UVB therapy and is expected to increase patient compliance.

Efficacy and safety of combined fractional ablative CO2 laser and 5 fluorouracil in the treatment of acral vitiligo: An open, uncontrolled study

“…Finally, it possesses the ability to damage some inhibitory agents or cells that might play a role in destruction of melanocytes thus inducing vitiligo. [13][14][15] In conclusion, the current study demonstrates that the combination of fractional ablative CO…”

“…18 The current study comes in line with the other studies documenting the efficacy of combining ablative methods with conventional modalities in the treatment of vitiligo. [12][13][14][15] However, some of these ablative modalities might carry the risk of delayed healing and scarring like in Er:YAG laser 12 or may be associated with difficulty in controlling the depth of ablation like in dermabrasion with possible koebnerization. 15 with traditional laser resurfacing.…”

“…In addition, it stimulates division of epidermal melanocytes of normal skin and reinforces their migration toward the vitiliginous areas. Finally, it possesses the ability to damage some inhibitory agents or cells that might play a role in destruction of melanocytes thus inducing vitiligo 13–15 …”

“…5 fluorouracil (5FU) has an immunomodulatory effect in treatment for vitiligo. It has shown good results in combination with Erbium‐YAG laser 12–14 and dermabrasion 15 …”

Comparison of NB‐UVB combination therapy regimens for vitiligo: A systematic review and network meta‐analysis

“…After browsing the full texts of the included articles, 136 studies were excluded for the following reasons: improper intervention or comparator ( n = 88), not RCT ( n = 43), no relevant outcomes ( n = 10), full‐text unavailable ( n = 5). Only 28 articles 19,25–51 were eligible for inclusion and progressed to the stage of data extraction. Finally, only 22 studies were included in the data analysis since the others had insufficient data.…”