Combined treatment with fractional carbon dioxide laser, autologous platelet-rich plasma, and narrow band ultraviolet B for vitiligo in different body sites: A prospective, randomized comparative trial

Abstract

Background: Multiple treatment options are introduced in treatment of vitiligo but the response is unsatisfactory.

Objective: In this prospective, randomized, comparative trial, we studied the effect of combined treatment with fractional carbon dioxide (CO₂ ) laser, platelet-rich plasma (PRP) injection, and narrowband ultraviolet B (NB-UVB) for stable nonsegmental vitiligo regarding repigmentation grade, patient's satisfaction, and side effects.

Methods: Eighty adult patients with localized nonsegmental vitiligo were enrolled in this study. The patients were randomly categorized to receive 4 lines of treatment; fractional CO₂ laser, PRP, combined fractional CO₂ laser and PRP, and combined fractional CO₂ laser and NB-UVB. The treatment period was 2 months. Patients were clinically evaluated 3 months after the last treatment. Outcome was evaluated by 5-point scale for repigmentation, 10-point visual analog scale for patient's satisfaction, and side effects.

Results: Laser and PRP group achieved the best results regarding repigmentation and patient's satisfaction. Sixty percent of the patients developed repigmentation >50% and 40% of patients developed repigmentation >75%. In laser and NB-UVB group, 5% developed repigmentation >75% and 25% developed repigmentation >50%. Only 10% of patients developed repigmentation >75% in laser group and only 20% of patients developed repigmentation >75% in PRP group.

Conclusions: Combination of fractional CO₂ laser with PRP injection is a promising treatment for vitiligo, followed by combination of fractional CO₂ laser with NB-UVB phototherapy. Both fractional CO₂ laser and PRP injection gave poor results if they received alone.

Keywords: laser; platelet-rich plasma; vitiligo.