Triple Combination Treatment With Fractional Carbon Dioxide Laser Plus Topical Halometasone Cream And 308nm Excimer Lamp For Vitiligo:A Clinical Study

Objective: Despite the numerous treatment modalities available for vitiligo,the treatment of refractory nonsegmental vitiligo（RNSV）remains unsatisfactory.Especially for acral vitiligo（AV）and phototherapy platform-stage vitiligo（PPV）which is defined as vitiligo of the whole body except on the acral regions without any improvement despite more than three months of continued treatment of phototherapy（NB-UVB,308 nm Excimer laser or 308 nm Excimer lamp）,in combination with topical steroids and/or calcineurin inhibitors（lesions on the face were treated with topical calcineurin inhibitors and the other lesions were treated with topical steroids）.So we did a clinical studies was conducted to investigate the effectiveness of triple combination therapy with 308-nm excimer lamp,fractional CO₂ laser and topical formulation.Methods: The 98 patients with 158 lesions of RNSV include AV group and PPV group.46 patients with 98 lesions of AV and 52 patients with 60 lesions of PPV were randomized divided into treatment group（T group）and control group（C group）.T group were performed with fractional CO₂ laser followed topical halometasone cream with a plastic film for 1st day post laser treatment,plus 308 nm excimer lamp after 3 days to 3months post treatment.C group were received treatment with 308 nm excimer lamp alone.308 nm excimer lamp treatment therapy was administered twice a week for 3months.Lesions were evaluated based on standardized digital pictures under visible and wood’s light by two blinded dermatologists.An investigator’s global assessment（IGA）was used with five grades of repigmentation（0,none;1,<25%;2,25-49%;3,50-74%;4,≥75%）.The criteria of success was a repigmentation of at least 50%（IGA 3 or 4）.The success rate=（lesions of IGA 3+lesions of IGA 4）/lesions in group×100%.Results: After three months of study,50% lesions in T group of PPV achieved success compare to 10% lesions in C group of PPV（p≤0.000）.8.16% lesions in T group of AV achieved success compare to 6.12% of C groupe of AV（p=0.425）.Conclusions: Triple combination therapy with fractional CO₂ laser plus topical halometasone cream and 308 nm excimer lamp has a definitive statistical effect for PPV.And this combination therapy can avoid the phototherapy platform-stage and shorten the treatment duration of PPV.While vitiligo on acrol part showed poor response to this combination treatment.