Effect Of Fractional CO₂ Laser On Vitiligo:A Meta-analysis

OBJECTIVE:The meta-analysis of this study was to evaluated the efficacy and safety of the combination therapy of fractional CO₂ Laser in the treatment for vitiligo.METHODS:The randomized controlled trial of Combination therapy of fractional CO₂ Laser in the treatment of vitiligo were searched from Pubmed,Embase,Corchrane library,CMB,CNKI,Wan-fang database and VIP database of Chinese journal on the time from January1,2014 to December 31,2018.According to inclusion and exclusion criteria,relevant studies were extracted data.the literature quality was assessed using the Cochrane risk bias assessment tool,and meta-analysis was performed using Revman 5.3.RESULTS:10 RCTs,including 367 patients whom were suffered from stable vitiligo were enrolled in this review.The total number of lesions in the experimental group was 353 patches,and in the control group was 348 patches.2 studies were on the combination therapy of fractional CO₂ Laser and topical drugs?hormones or tacrolimus?.3studies were on the double combination therapy of fractional CO₂ Laser and ultraviolet phototherapy?or 308 phototherapy?,5 studies were on the triple combination therapy of fractional CO₂ Laser and topical drugs and phototherapy.Meta-analysis showed that the double combination group had significantly lower 0% repigementation rate in the treatment of vitiligo than the control group?RR=0.37,95%CI=0.26-0.53,P<0.00001?,and also had significantly lower?25% repigementation rate in the treatment of vitiligo than the control group?RR=0.61,95% CI=0.40-0.92,P=0.02<0.05?;The double combination group had higher?50% repigementation rate in the treatment of vitiligo than the control group?RR=2.14,95% CI=1.52-3.03,P<0.0001?,but had no significant difference in?75% repigementation rate in the treatment of vitiligo than the control group?RR=3.57,95% CI=0.3-36.72,P=0.28>0.05?.The triple combination group had significantly lower?25% repigementation rate than the control group?RR=0.66,95% CI=0.47-0.93,P=0.02<0.05?,and had significantly higher?50% repigementation rate than the control group?RR=1.73,95% CI=1.14-2.63,P=0.01<0.05?,But there was no significant difference in 0% repigementation rate between the triple combination group and the control group?RR=0.72,95% CI=0.46-1.13,P=0.16>0.05?.There was also no significant difference in?75%repigementation rate of vitiligo between the triple combination group and the control group?RR=1.89,95% CI=0.92-3.89,P=0.08>0.05?.The meta-analysis concluded that the?50%repigementation rate in the combination group was higher than control group?RR=4.12,95% CI=1.66-10.19,P=0.002<0.05? for the treatment of the hand and foot parts in vitiligo.In addition,the analysis revealed significantly higher satisfaction?VAS score? in the combination group than control group?SMD=2.23,95% CI=1.23-3.23,P<0.0001?.CONCLUSION:The combination therapy of fractional CO₂ Laser can significantly improve the repigementation rate of vitiligo.