A triple combination of latanoprost, fractional CO2 laser, and platelet-rich plasma in localized vitiligo: A clinical and histopathologic study

Abstract

Background: Several treatment modalities are available for the treatment of vitiligo due to the lack of a uniformly effective therapy. Topical latanoprost 0.005% is an effective topical treatment. Fractional CO₂ laser alone or combined with platelet-rich plasma (PRP) has been proposed as effective adjunctive therapies.

Objectives: We aimed to compare the efficacy of topical latanoprost 0.005% (Ioprost®, Orchidia, Egypt) combined with either add-on fractional CO₂ laser or fractional CO₂ -PRP versus topical latanoprost monotherapy in the treatment of localized stable vitiligo.

Patients/methods: The study included 60 patients randomly assigned into three equal groups. Group A patients received topical latanoprost drops only. Group B patients received topical latanoprost drops and fractional CO₂ laser sessions at 2-week interval for 3 months. Group C patients received topical latanoprost drops and fractional CO₂ laser sessions combined with PRP at a 2-week interval for 3 months. The mean improvement score by the physician was calculated 4 months after the start of the study. Punch skin biopsies were obtained before treatment and 4 months from the beginning of the study and stained with H&E and HMB-45 antibody for evaluation of pigmentation.

Results: Significant clinical improvement of vitiligo lesions with significant increase of re-pigmentation were reported in the three treated groups. Latanoprost in combination with fractional CO₂ and PRP was associated with more significant therapeutic outcomes than either combined latanoprost and fractional CO₂ or latanoprost alone.

Conclusion: Fractional CO₂ laser-PRP enhances the therapeutic efficacy of latanoprost 0.005% in the treatment of localized stable vitiligo.

Keywords: PRP; fractional CO2; latanoprost; vitiligo.