Triple combination of fractional carbon dioxide laser, 308-nm excimer lamp, and platelet-rich plasma in refractory vitiligo: A randomized split-body comparative study.

Abstract

Objectives: Vitiligo significantly impacts patients' quality of life. Current evidence indicates that combination therapy results in faster improvement, enhancing patient adherence to treatment and leading to higher satisfaction among patients. In this study, we compare the efficacy of combined fractional carbon dioxide (FCO₂) laser and excimer lamp with platelet-rich plasma (PRP) or topical tacrolimus in patients with refractory vitiligo.

Material and methods: This is a prospective, single-blind, randomized split-body clinical trial involving 41 patients with resistant focal patches of vitiligo vulgaris. Each patient had two similar lesions randomly assigned to receive either a combination of FCO₂ laser, excimer lamp, and intradermal PRP injections or a combination of FCO₂ laser, excimer lamp, and topical 0.1% tacrolimus (applied twice daily for 12 weeks). The FCO₂ laser and PRP treatments were administered in three monthly sessions, and the excimer lamp was used twice a week over 12 weeks. The efficacy of treatment was assessed based on the physician's assessment and patient's satisfaction.

Results: Despite significant improvement in both treatment groups during the course of treatment, the PRP group showed significantly superior efficacy (more than 50% improvement) compared to the tacrolimus group (56.1% and 26.8%, respectively). Furthermore, the PRP group exhibited greater improvement in resistant acral areas compared to the tacrolimus group (51.2% and 19.5%, respectively).

Conclusion: The combination of FCO₂, an excimer lamp, and PRP demonstrates superior efficacy, particularly in resistant acral areas. As a result, this combination can be recommended in difficult-to-treat areas in patients with vitiligo.