Study of efficacy of excimer laser in localised vitiligo

 

Chaithanya K¹, M Madhavi Latha^2*, T Praveena³

 

Abstract              Background: Vitiligo is an acquired, often progressive disorder of hypopigmentation, clinically manifested by circumscribed achromic macules often associated with leukotrichia. The estimated incidence in India is 3%-4%. various modalities of treatment have been tried with variable outcomes. Aim: To study the effect of Excimer laser (308-nm UVB radiation) in patients with localized vitiligo. Methods: Thirty patients (19 females, 11 males) with localized vitiligo, denovo, or who had tried various modalities of treatment (including topical and systemic drugs) were enrolled in the study. Of the 30 subjects, 17 had lip vitiligo, 13 had focal vitiligo (over elbows, wrist, dorsum of the hand, and foot). Treatment with excimer laser was done twice or thrice weekly after calculating MED dose and increased by 20mj/cm2 in every session. Objective and subjective assessment was done after every 2 months. Results: At the end of the study period, 47% (14/30) of patients showed good response in lesions located on the face, trunk, arm, and/or leg (high-responder location), and after 15 sessions, 33% (10/30) of patients showed a moderate response in lesions located on the elbow, wrist, dorsum of the hand, knee, and/or dorsum of the foot (low-responder location),20% (6/30) of patients showed poor response. Conclusion: 308nm excimer laser is effective in patients with localized vitiligo. However, the therapeutic effect is mainly dependent on the location of vitiligo lesions.

 

INTRODUCTION

Vitiligo is an acquired, often progressive disorder of hypopigmentation, clinically manifested by circumscribed achromic macules often associated with leukotrichia. Both genetic and epigenetic factors seem to play a role in the etiopathogenesis of vitiligo. Vitiligo is associated with many skin disorders like canities, alopecia areata, atopic eczema, thyroiditis, diabetes mellitus. It commonly involves people with 3 and 4 fitzpatrick skin types and a higher incidence among patients with atopic dermatitis. Excimer laser in which “excimer” is a terminological reference of “excited dimer”. The 308 nm excimer laser, a xenon-chloride excimer laser, a novel mode of phototherapy, is an ultraviolet B radiation system consisting of noble gas and halide which repel each other. The mechanism of action of the excimer laser, similar to the action of UVB light, induces apoptosis in keratinocytes and T lymphocytes. It is recommended when the lesions involve less than 20% of the body, treatment is given twice or thrice weekly.

 

MATERIALS AND METHODS

An observational prospective study was conducted in patients presenting with vitiligo to the outpatient department of DVL of Santhiram Medical College and General Hospital, Nandyal, from November 2020 to April 2021. The institutional committee approval was taken and written informed consent was taken from all study subjects Patients are those who are willing to give informed written consent and who are willing to participate in the study. Patients having localized patches of vitiligo, denovo, or who had tried various modalities of treatment (including topical and systemic drugs). Patients of ages (10-50 years) and both sexes were included in the study. Widespread lesions, pregnancy and lactating, and patients having a history of photosensitivity were excluded. Patients with other hypopigmented skin lesions and not clinically correlating with a diagnosis of vitiligo were excluded from the study. Detailed history and complete cutaneous examination were done. Based on the vitiligo activity, a score was assigned which is a 6 point scale for evaluating vitiligo activity, based on the patient's reports of disease activity. This was calculated and scored as: 4+ (active in past 6 weeks);3+ (active in past 3 months); 2+ (active in past 6 months); 1+ (active in past 1 year); 0 (stable for at least 1 year); 1- (stable for at least 1 year with spontaneous repigmentation). Digital photographs were taken. Excimer laser irradiation was started after calculating MED dose and increased by 20mJ/cm2 for every two sessions after taking necessary precautions as protecting eyes and surrounding normal skin. Objective (Visual assessment which includes physician’s global assessment, visible light photography, UV light photography) and subjective assessment (vitiligo disease activity score) were done after 2, 4 and 6 months. Less than 25% improvement after treatment was considered as a failure to treat, 25%-50% as a poor response, 50%-75% as a good response, and >75% as an excellent response.

 

RESULTS

This study sample consisted of 30 patients, where the majority belonging to the age group of 30-40 years. Six cases had a positive family history. Vitiligo was associated with other diseases as Diabetes Miletus in 14 cases, Thyroid disorder in 11 cases, Alopecia areata in 1case, and Atopic dermatitis in 4 cases. Repigmentation started over the lesions after an average of 13 treatments, lesions located on the face, trunk, arm, and/or leg (high-responder location), and after a mean of 22 treatments in lesions located on the elbow, wrist, dorsum of the hand, knee, and/or dorsum of the foot (low-responder location). Lips were most commonly involved followed by the elbow, wrist, dorsum of foot, dorsum of the hand. Of 17 patients who had lip vitiligo, 4 (23.5%) patients achieved a good response, 7 (41.1%) patients achieved a moderate response, 6 (35%) achieved a poor response. Of 13 focal vitiligo patients, 5 patients having lesions over trunk and waist achieved good response (38%), 8 patients having lesions over acral areas achieved poor response (61.5%). At the end of 10 sessions, 47% (14/30) of patients showed good response, 33% (10/30) of patients showed a moderate response, 20% (6/30) of patients showed a poor response at the end of 15sessions The ultimate repigmentation initiation depends entirely on the total number of treatment sessions rather than the frequency

 

TABLE 1: Age distribuition

 

TABLE 2: Sex distribuition

 

TABLE 3: Distribuition of disease

 

TABLE 4: Association with other diseases

 

TABLE 5: Association with family history

 

 

 

 

 

 

 

 

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