Treatment of stable nonsegmental vitiligo using transdermal delivery of 5‐fluorouracil by fractional CO₂laser versus intralesional injection of 5‐fluorouracil, both followed by narrow‐band type ultraviolet B (UVB): A comparative study

Abstract

Background Updates of treatment methods of stable vitiligo are needed to give better outcomes with a shorter duration of treatment. Objective To test the effect of transdermal 5‐fluorouracil (5‐FU) delivery using fractional CO2 (FrCO2) laser versus intralesional 5‐FU injection, with narrow‐band type ultraviolet B (UVB) (NB‐UVB) therapy after both, in the treatment of stable vitiligo. Patients and methods The present study comprised 40 patients with nearly symmetrical stable vitiligo lesions. The left side was treated with FrCO2 laser followed by topical 5‐FU (FrCO2 + 5‐FU), while the right side was treated with 5‐FU intradermal injection. Both procedures were done at 2‐week intervals for 3 sessions followed by 24 sessions of narrow‐band UVB for both sides. Results Repigmentation was demonstrated on the left side of 90% of patients and the right side of 85% of patients. As much as >50% improvement was demonstrated on the left side of 50% of patients, and the right side of 55% of patients. Intralesional 5‐FU showed a statistically significant difference in repigmentation compared to FrCO2 + 5‐FU. Conclusion Both 5‐FU injection and FrCO2 + 5‐FU were effective therapeutic modalities for vitiligo. Patients were more compliant with FrCO2 + 5‐FU.

Comparative Study between the Efficacy of Trichloroacetic Acid 30% versus Intradermal 5 Fluorouracil Injection in Treatment of Vitiligo with or without Narrow Band Ultraviolet B Phototherapy

“…The comparison between lesion 1 treated with TCA+NBUVB and lesion 2 treated with 5-FU+NBUVB in group B regarding PGA score, our study displayed no significant difference among the subgroup patients treated with TCA + NBUVB compared to treatment with 5-FU+ NBUVB (P > 0.05). Such findings highlighted the equal efficacy of the combining treatment of NBUVB with either TCA 30% or 5-FU, with statistically significant increase in the burning sensation among TCA + NBUVB-treated lesions and a statistically significant increase in the perilesional hyperpigmentation among 5-FU + NBUVB treated A comparative study by Elgarhy et al [20] revealed that both 5-FU injection plus NBUVB and FrCO2 plus 5-FU plus NBUVB were effective therapeutic modalities for vitiligo. Patients were more compliant with FrCO2 plus 5-FU plus NBUVB in the management of stable vitiligo.…”

Dynamic panoramic presentation of skin function after fractional CO2 laser treatment

“… 41 For example, a prospective, single-blinked study reported in 2022 found that fractional CO 2 laser combined with 5-fluorouracil had a more significant effect on re-pigmentation than 5-fluorouracil alone, and the patient’s compliance was higher. 42 However, there is no specific time range for the external use of drugs after fractional CO 2 laser, but it is believed that the best effect can be achieved within 24 h after treatment, according to the change in tissue structure. Because at this time, the epidermis is vaporized to form a pore to transport drugs.…”

Phototherapy for vitiligo: A narrative review on the clinical and molecular aspects, and recent literature

“…92 Both intradermal injection of 5-FU alone and combined treatment with fractional CO2 laser and 5-FU were effective therapeutic modalities for vitiligo, when followed by 24 sessions of NBUVB. 93 Er:YAG laser ablation followed by 5-FU application prior to NBUVB phototherapy for vitiligo fared better than NBUVB therapy alone. 94 Topical pseudo-catalase cream did not provide additional benefit to NB-UVB therapy for treating vitiligo.…”

“…No systemic side effects of 5‐FU were observed, but most patients experienced injection‐related pain 92 . Both intradermal injection of 5‐FU alone and combined treatment with fractional CO2 laser and 5‐FU were effective therapeutic modalities for vitiligo, when followed by 24 sessions of NBUVB 93 . Er:YAG laser ablation followed by 5‐FU application prior to NBUVB phototherapy for vitiligo fared better than NBUVB therapy alone 94 .…”