Fractional carbon dioxide laser, platelet –rich plasma and narrow band ultraviolet B in the treatment of Vitiligo (A prospective randomized comparative trial)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abdullah Eshafi ◽  
Nehal Mohamed Zuelfakkar ◽  
Ahmed Abd Elfattah Afify
Keyword(s):  
Patient Satisfaction ◽  
Co2 Laser ◽  
Platelet Rich Plasma ◽  
Ultraviolet B ◽  
Treatment Modalities ◽  
Computer Assisted ◽  
Triple Combination ◽  
Patient Satisfaction Score ◽  
Triple Combination Therapy ◽  
Melanin Pigmentation

Abstract Vitiligo is a disease that causes the loss of skin color in patches due to loss of melanin pigmentation of specific areas of the skin. Although several hypotheses have been proposed, the leading theory is still the auto-immune etiology linked to specific genetic mutations. Vitiligo can also be associated with several autoimmune diseases. There is no curative treatment for vitiligo but, several treatment modalities are considered. Topical therapies like steroids and Calcineurin inhibitors are of popular use in clinical settings also, steroids can be administered systemically in vitiligo patients. Physical therapies as fractionated CO2 (Fr: CO2) laser and Narrowband-UV (NBUV) phototherapy represent a gold standard in treatment in clinical practice. Moreover, intralesional therapies are emerging, one of which is autologous platelet-rich plasma injection. Aim of the study This study aimed to evaluate and compare the efficacy and safety of Fr: CO2 laser, PRP, combined Fr: CO2 laser and PRP, combined Fr: CO2 laser and NB-UVB, combined Fr: CO2 laser, PRP and NB-UVB in the treatment of vitiligo as well as reporting the side effects. Patients and methods This study included 20 vitiligo patients with at least 6 patches of stable vitiligo (120 patches), the patches were divided into six groups according to the treatment modality. Assessment of treatment response was done through patient satisfaction score and Vitiligo analysis by computer-assisted grid (VACAG). Results Regarding surface area reduction in included patients, fractional CO2 laser achieved the best results followed by triple combination therapy (CO2 with PRP and NB-UVB), the least response was with CO2 with PRP treatment. Patient satisfaction in the current study had a different outcome, PRP treated patients exhibited the highest satisfaction scores while triple combination treated group showed the least satisfaction scores.

scholarly journals A PROSPECTIVE INTERVENTIONAL STUDY COMPARING THE EFFICACY OF FRACTIONAL CO2 LASER AND MICRONEEDLING COMBINED WITH AUTOLOGOUS PLATELET RICH PLASMA IN MANAGEMENT OF STRIAE DISTENSAE

2021 ◽  
pp. 57-60
Author(s):  
Sanjay Meena ◽  
Ashok Meherda ◽  
Rajkumar Kothiwala ◽  
Kapil Vyas
Keyword(s):  
Co2 Laser ◽  
Platelet Rich Plasma ◽  
P Value ◽  
Striae Distensae ◽  
Patient Satisfaction Score ◽  
Efficient Treatment ◽  
Fractional Co2 Laser ◽  
Autologous Platelet Rich Plasma ◽  
Group 2 ◽  
Autologous Platelet

Background:Striae distensae is a very common condition with irregularly linear, several centimetres long. There are numerous therapeutic modalities available with variable efficacy but none are proven treatment. A Aim and objectives: comparative study of Fractional CO2 Laser Versus Microneedling With Autologous platelet Rich Plasma in striae distensae. This study was conducted from november 2016–2017 and included 52 patients of striae dist Methods: ensae where Group-1 of striae treated by microneedling with autologous PRP and Group-2 treated with Fractional CO2 laser. Randomized prospective study was conducted for a period of 16 weeks. Clinical photographs were taken immediately before and 4 weeks after fourth treatment and VAS score and patient satisfaction score was obtained at the baseline and at the end of 20 weeks to see treatment response. As per the VAS system, mean VAS in the patients Gr Results: oup-1 treated by microneedling with prp was 0.8462± 0.3397 at 4 weeks, which later increased to 2.577± 0.6737 at 20th week i.e. 4 weeks after the last sitting. Mean VAS in patients Group-2 treated by Fractional co2 laser was 1.077±0.3374 at 4 weeks, which later increased to 3.077±0.7706 at 20th week i.e. 4 weeks after the last sitting.The difference in mean VAS at 4th week between two groups was statistically significant with a p-value of <0.05(0.0110). The difference in mean VAS at 20thth week between two groups was statistically significant with a p-value of <0.05(0.0100). Both groups of the patients showed statistically significant improvement in striae distensae at the end of 20th weeks however Fractional CO2 laser versus microneedling with autologous PRP was more efficacious in decreasing the extent of striae distensae. Conclusion:Study concluded microneedling with Autologous PRP, and Fractional CO2 Laser both can serve as a safe and efficient treatment in cases of striae distensae but fractional CO2 laser more efficaceous.

Vitiligo: An Updated Narrative Review

2020 ◽  
Vol 16 ◽  
Author(s):  
Alexander K. C. Leung ◽  
Joseph M. Lam ◽  
Kin Fon Leong ◽  
Kam Lun Hon
Keyword(s):  
Present Article ◽  
English Literature ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Calcineurin Inhibitors ◽  
Ultraviolet B ◽  
Lower Limbs ◽  
Treatment Modalities ◽  
Topical Corticosteroids ◽  
Topical Calcineurin Inhibitors

Background: Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. Objective: This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. Methods: A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included metaanalyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature. The information retrieved from the above search was used in the compilation of the present article. The information retrieved from the above search was used in the compilation of the present article. Results: Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. Conclusion: The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment of choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.

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