Effect Of Fractional CO2 Laser Combined With Tacrolimus Ointment And Rb-bFGF In The Treatment Of Refractory Vitiligo

Objective:To observe the clinical efficacy of Recombinant Bovine Basic Fibroblast Growth Factor Gel(rb-b FGF)and 0.1% tacrolimus ointment combined with fractional CO2 laser,and use rb-b FGF combined with 0.1% tacrolimus ointment in the treatment of refractory vitiligo(RV),analyzes whether there is a difference in the efficacy of the two,evaluates its effectiveness and safety,and provides clinical basic research for the clinical application of fractional CO2 laser.Methods:From June 2019 to February 2020,35 patients with refractory vitiligo were enrolled according to the entry criteria in the dermatology clinic of Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital.Two pieces of skin lesions were selected from symmetrical parts of patients.For patients with limited skin lesions,one piece of skin lesions was divided into two parts averagely.Two pieces or two parts of skin lesions were randomly divided into observation group 1 and observation group 2,35 lesions in each group,the efficacy of the two groups were evaluated and compared by self-control.The observation group 2 was treated with rb-b FGF and 0.1% tacrolimus ointment twice a day.The observation group 1 was treated with fractional CO2 laser on the basis of topical drugs.The laser treatment was performed once every 4 weeks,3 times in total.The area of skin lesions,the recovery rate of vitiligo lesions were recorded at baseline,the 4th,8th and 12 th weeks after baseline.Compare at each recorded time point whether there is a difference in the efficacy between the two groups.Analysis in the observation group 1,with the increase of treatment times,whether there is a difference in treatment efficiency.The correlation coefficient analysis was used to evaluate the factors influencing the final recovery of skin lesions.At the end of the study,10 point visual analogue scale(VAS)was used to evaluate the patients’ satisfaction with the treatment and to compare whether there was any difference between the two groups.Result:1.In the 4th,8th and 12 th week of treatment,the effective rate of the observation group 1 was better than that of the observation group 2,and at the 12 th week,the difference between the effective rate of the observation group 1(85.71%)and the observation group 2(62.86%)was statistically significant(P < 0.05).In the observation group 1,there was no significant difference in the effective rate(60.00%)at the 4th week and that at the 8th week(68.57%),and there was significant difference in the effective rate(85.71%)at the 12 th week and that at the 4th and 8th weeks(P < 0.05);2.In the observation group 1,there was a negative correlation between the recovery rate of vitiligo lesions at the end of treatment and the area before treatment(r =-0.463,P < 0.01),regardless of the age.There was no statistical difference in the recovery rate of vitiligo lesions between different genders and the course of disease;3.At the end of the treatment,the average score of patients’ satisfaction in the observation group 1 was 4.63 ± 1.592 points,and the average score in the observation group 2 was 3.43 ± 1.520 points.The VAS in the observation group 1 was higher than that in the observation group 2,there was statistical difference between the two groups(P<0.01).For the forms of repigmentation,the mixed repigmentation is the main one,there was no significant difference between the two groups(P>0.05).There were no serious adverse reactions during the whole progress of the study.Conclusion:1.The efficacy of rb-b FGF and 0.1% tacrolimus ointment combined with fractional CO2 laser in the treatment of RV is accurate.It can significantly reduce the area of skin lesions and improve the recovery rate of vitiligo lesions.Its effective rate is better than that of topical drugs alone;2.Increasing the treatment time can get a higher recovery rate of vitiligo lesions;3.The smaller the area of the skin lesion,the higher the recovery rate obtained at the end of the treatment.There is no obvious adverse reaction in the whole performance.The number of cases can be expanded to further verify the results obtained.