Vitiligo and the Effect of Laser Treatment: An Annotated Bibliography

 ‌Boukari F, Lacour JP, Ortonne JP, Bahadoran P, Passeron T. 2012. Laser-assisted depigmentation for resistant vitiligo: a retrospective case series with long-term follow-up. Journal of the European Academy of Dermatology and Venereology. 28(3):374–377. doi:https://doi.org/10.1111/jdv.12038

In this article, patients with vitiligo that have used creams that can lighten the skin are effective but have side effects that limit their use. They described that cryotherapy could also be used but is only effective for small areas and has side effects such as pain, scarring, skin irritation. While the Q-switched lasers have been used to depigment normal skin in vitiligo, there is limited data on their long-term effectiveness. This study’s primary purpose is to investigate Q-switched lasers’ long-term efficacy and safety for depigmenting the remaining unaffected skin in vitiligo. Patients treated with Q.S. lasers in the Department of Dermatology at the University Hospital of Nice, France, from 2002 to 2011 were selected and evaluated at the center. In addition, data on their demographic information, history of vitiligo, and use of photoprotection were collected. The study analyzed the treated lesions’ localizations and percentage of body surface area, type of Q.S. lasers, parameters used, the total number of sessions, and possible relapses and side effects. The depigmentation achieved was assessed by comparing before and after treatment photographs. Patient satisfaction was evaluated using a visual analogical scale from 0 to 10.

 This study involved six patients with vitiligo that had spread to at least 50% of a body area and had not responded to other treatments. The patients agreed to return for a follow-up visit, where they were treated with three types of Q.S. lasers: 694 nm ruby laser,755 nm Alexandrite, and 532 nm Nd: Yag laser. As a result, 16 areas of skin had lost their pigment. Different settings for each person and treated between 5 to 15% of their body. On average, it took two treatments to make the skin all one color. They followed up with the patients for about 36 months and found that one-third had no problems again. One patient’s skin returned to normal after 21 months, and another was half normal after seven months. Two patients had a small amount of color come back after 18 months and nine years, but they could fix it with more treatments. The patients only had minor side effects like temporary bruises and scabs.

Furthermore, no connections were found between using sunscreen, what kind of skin the patients had, and how long they had vitiligo. The exact number of treatments were conducted, but the only places where the vitiligo did not return were the upper arms and trunk. The patients had an average of 3 treatments and only had minor side effects like temporary purple spots and scabs. Most patients did not need pain medicine during the treatments, and most were satisfied. Overall nine patients who did not respond to topical 4-methoxy phenol blanching creams were treated with a ruby Q.S. laser, and it was effective after only one session with a follow-up period of 9 months. The ruby Q.S. The laser was used when topical 4-methoxy phenol failed to work, and 69% of patients achieved complete depigmentation with the cream. Four of the five patients who did not respond to the cream had successful depigmentation with the Q.S. laser. The relapse rate with the Q.S. laser was 44%, but two additional cases were reported as effective with no relapse after one year. This is the first report of vitiligo patients being treated with Q.S. laser, and the results show that it is effective with few side effects and high patient satisfaction. All three types of Q.S. lasers used are effective. However, the small number of patients and the different lasers used make it difficult to conclude their effectiveness. On average, patients required less than six sessions, including treatment and maintenance, over a follow-up period of more than 48 months. One patient had 20 sessions but was treated for ten years and only needed one or two yearly maintenance treatments. Despite using photoprotection, five out of six patients observed repigmentation in the face, neck, and hands after summer, indicating the potential role of sun exposure in relapses. The patients’ use of sunscreens was not enough to prevent relapses. 

This article is reliable. It provides well-based argument and evidence, and its author F. Boukari, J.P. Lacour, J.P. Ortonne, P. Bahadoran, T. Passeron, credentials of the Department of Dermatology, University Hospital of Nice and INSERM, U1065, Centre Méditerrané en de Médecine Moléculaire (C3M), team 12, Nice, Franc. This article would contribute to my lit review due to the main focus of its study in which both laser and blanching creams have similar relapse rates with advantages and disadvantages. Bleaching creams can be used on larger areas, but they take longer to work( 6 to 12 months) and have more side effects. Laser treatments require fewer sessions and have better results but are more expensive and only work in smaller areas. The study demonstrated that Q.S. lasers are a safe and effective method for depigmenting  worked well for about half of the patients studied.This study provides evidence of objective success and investigates its long-term effects. They collected data for the analysis for years, while the other articles only lasted at least a year/ few months.

Komen L, Zwertbroek L, Burger SJ, van der Veen JPW, de Rie MA, Wolkerstorfer A. 2013. Q-switched laser depigmentation in vitiligo is most effective in active disease. British Journal of Dermatology. 169(6):1246–1251. doi:https://doi.org/10.1111/bjd.12571

This article used the 694-nm QSR laser to treat eligible patients of vitiligo. A spot was treated first and evaluated after six weeks; further laser treatments were done if no side effects were found. The maximum size treated per session was 50-100 cm2, and the treatment was repeated every 6-8 weeks until the entire pigmented area was treated. If repigmentation occurred, patients could receive laser treatments once more for those areas. The main focus of this study was to measure the amount of skin that lost its pigment after laser treatment and to demonstrate that patients with active vitiligo have better results than patients with stable vitiligo. Moreover, firstly, pictures of the patient’s skin before/ after treatment and ranked the amount of depigmentation on a scale of poor to excellent percentages. If more than one skin area was treated, each site was photographed, and the average amount of depigmentation was calculated. A Questionnaire was created with multiple-choice and open-ended questions about the patient and their illness. It covered demographics, overall health, treatment outcomes, repigmentation, patient satisfaction, and specific aspects of vitiligo, such as the Koebner phenomenon and disease activity.

 An experiment and survey were conducted with 63 vitiligo patients treated with the laser. Only 48 were asked to be part of the study. Fifteen could not be in the study because their pictures were missing or unclear. Out of the 48 people invited, 27 agreed to be in the study. There were 27 patients in the study, 15 female and 12 male. They had different types of skin, and 18 of them had about > 80% depigmentation. The patients had vitiligo for an average of 25 years, and most had it on their faces. At treatment, vitiligo was active in 17 patients (63%) and stable in eight (30%). However, for two patients, they could not recall the activity of their vitiligo. Out of 27 people who got special treatment, 18 had temporary problems like redness, scabbing, and itching, but they were brief.

 None of them got any bad scars or infections. One person stopped getting the treatment even though it was helping them due to the temporary pain. Three, four, and seven patients presented moderate, fair, and poor results after laser treatment. Three of the seven individuals with low outcomes demonstrated a notable increase in pigmentation following laser therapy. As a result, about half of the people we treated had their skin color return to normal by more than 75% after 13 months. Using QSR laser treatment to remove skin pigmentation is safe and does not cause any harmful effects in the long term. And that 85% of patients were happy with the treatment and 93% would recommend it to others. The study found that QSR laser therapy is an effective treatment with high patient satisfaction and no long-term side effects.. And discovered that people with active vitiligo had better results than those who had a stable condition. This is the first time anyone has shown this.Therefore, Q.S. lasers should be the first option for small lengths that need depigmentation. However, patients should be informed that repigmentation may be delayed. Testing the treatment on a small area of the patient’s skin and following up after six weeks is recommended. If the treatment is inadequate for patients with stable vitiligo, it is best to wait until it becomes active before restarting treatment.

The article is a reliable source that includes detailed evidence and explanations of the data collected, and its study focus differs from other sources. The credentials for the author L. L. Komen, L. Zwertbroek, S.J. Burger, J.P.W. van der Veen, M.A. de Rie, A. Wolkerstorfer are Netherlands Institute for Pigment Disorders, Department of Dermatology, Academic Medical Centre, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands. The study’s main goal was to show that patients with active vitiligo have better results than those with stable disease. The Q-switched laser was also a safe and effective treatment for depigmentation in patients with widespread vitiligo. The research includes a flow chart summarizing the recruitment of study participants, a table describing the characteristics of the study population, and a graph showing the number of patients with active and stable vitiligo concerning the degree of depigmented skin. The degree of depigmented skin was calculated after assessment by two blinded physicians. The researchers also collected patients’ information and conducted follow-ups after the study. Overall, the article provides a detailed research study and evidence of the patients.

Monique, Westerhof W. 1997. Laser treatment for further depigmentation in vitiligo. International Journal of Dermatology. 36(5):386–388. doi https://doi.org/10.1046/j.1365-4362.1997.00144.x.

The article includes information about laser treatment for pigmentation in vitiligo. It starts with a short explanation of vitiligo and discusses the treatment of Q-Switched Ruby, the laser used in this study. However, it also discusses another treatment of a cream that contains four methoxy phenol, a bleaching substance to remove the color from certain parts of our skin; it is an option but does not succeed for the patients. The main argument in this study is to prove the effectiveness of the laser treatment over the cream. In this study, surveys and an experiment were conducted, and finally, they received feedback from 3 patients on the laser treatment. Which removes some cells called melanocytes using a special laser that sends a beam of light deep into the skin. The laser is good at targeting the pigment in the melanocytes. The laser is so fast that it does not make the skin around the melanocytes get too hot, so it does not hurt the skin or leave scars. The study was conducted in which Eight people with vitiligo had spots on their bodies. Before the laser treatment, they had used a bleaching cream containing four methoxyphenyl, but it did not work. The patients had to answer questions and sign a paper agreeing to the treatment.

Furthermore, depending on their skin type, the laser gave them different amounts of energy. After the treatment, they had to be careful to avoid sunlight after 3, 6, and 9 months. As for the Results, The average age of the patients was 31 years old, and they had been sick for about 14 years. Over a nine-month follow-up period, five patients developed follicular depigmentation, likely due to residual melanocytes migrating to the skin’s surface. Four patients found the treatment painful, and Three patients reported a positive Koebner phenomenon and remained depigmented in the treated areas.

The article informs and persuades the use of laser treatment for vitiligo and is a reliable source that supports its main argument with evidence. Moreover, the authors: Dr. Monique Thissen is a dermatologist and faculty member at the University of Maastricht who has completed a Ph.D. thesis on treating basal cell carcinoma with photodynamic therapy. Moreover, Wiete Westerhof is a researcher at the University of Amsterdam who has worked on studies related to vitiligo and melanocyte, with many publications and citations. Although in comparison with the other articles, the information presented is more straightforward and similar to an audience paper. Furthermore, the variety of patients is low, as well patients were using other treatments, which would have affected the results of this study. Finally, this article would contribute to the lit review by discussing the effectiveness of the treatment by laser over the cream, which has methoxy phenol, and more detail on the severe side effects for the patient’s skin. 

Vitiligo and the Effect of Laser Treatment: An Annotated Bibliography Draft 

Monique, Westerhof W. 1997. Laser treatment for further depigmentation in vitiligo. International Journal of Dermatology. 36(5):386–388. doi:https://doi.org/10.1046/j.1365-4362.1997.00144.x

The article includes information about laser treatment for pigmentation in vitiligo. It starts with a short explanation of vitiligo and discusses the treatment of Q-Switched Ruby, the laser used in this study. However, it also discusses another treatment of a cream that contains four methoxy phenol but fails to affect the patients. The main argument in this study is to prove the effectiveness of the laser treatment over the cream, which the patients did not find success in minimizing/eliminating the depigmented patches of skin caused by vitiligo. In this study surveys, a and an experiment were conducted, and final tent, they received feedback from 3 patients on the laser treatment. Which removes some cells called melanocytes using a special laser that sends a beam of light deep into the skin. The laser is good at targeting the pigment in the melanocytes. The laser is so fast that it does not make the skin around the melanocytes get too hot, so it does not hurt the skin or leave scars. The study was conducted in which Eight people with vitiligo had spots on their bodies. Before the laser treatment, they had used a bleaching cream containing four methoxyphenyl, but it did not work. The patients had to answer questions and sign a paper agreeing to the treatment. And Depending on their skin type, the laser gave them different amounts of energy. After the treatment, they had to be careful to avoid sunlight after 3, 6, and 9 months. As for the Results, The average age of the patients was 31 years old, and they had been sick for about 14 years. Over a nine-month follow-up period, five patients developed follicular depigmentation, likely due to residual melanocytes migrating to the skin’s surface. Four patients found the treatment painful, and Three patients reported a positive Koebner phenomenon and remained depigmented in the treated areas

This article informs ans persuade the used of laser treatment for vitiligo. The authors firstly Dr. Monique Thissen is a dermatologist and faculty member at the University of Maastricht who has completed a PhD thesis on treating basal cell carcinoma with photodynamic therapy.And  Wiete Westerhof is a researcher at the University of Amsterdam who has worked on studies related to vitiligo and melanocyte, with a high number of publications and citations.Although in comparison with the other articles the information being presented its more simple and most similar as a audience paper. And the variety of patient its low, as well patients were in used of another treatment which would of effect the results of this study.

Ghasemloo S, Gauthier Y, Ghalamkarpour F. 2019. Evaluation of using fractional CO2 laser plus NB-UVB versus NB-UVB alone in inducing marginal repigmentation of vitiligo lesions. Journal of Dermatological Treatment. 30(7):697–700. doi:https://doi.org/10.1080/09546634.2018.1564232

Narrow band-UVB phototherapy is a popular treatment for vitiligo, which can result in different repigmentation patterns. Perifollicular repigmentation is the most common, while marginal repigmentation is more difficult to achieve in non hairy areas. Combination therapies, such as the use of fractional CO2 laser, have been used to enhance repigmentation. A study was conducted to compare the effectiveness and safety of NB-UVB alone versus NB-UVB combined with fractional CO2 laser in vitiligo patients who did not respond to previous treatments. Marginal repigmentation was evaluated by performing laser skin ablation at the margin of the vitiliginous patches.

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