Efficacy and Effects of Q-Switched Laser and Creams in the Treatment of Vitiligo: A Literature Review 

Abstract

This review examines the effectiveness and potential side effects of Q-switched laser treatment and depigmentation creams for treating vitiligo. Q-switched lasers have been shown to depigment skin affected by vitiligo but can cause temporary side effects like redness and crusting. Depigmentation creams may cause severe side effects, while cryotherapy can result in pain and scabbing. Laser treatment has a high success rate and can be combined with depigmentation creams, but careful assessment and monitoring of long-term safety and efficacy is necessary. Overall, this review emphasizes the importance of personalized treatment approaches and critically evaluates available evidence on these treatments for vitiligo.

Introduction

Vitiligo is a skin condition that affects a small percentage of the population, causing white patches on the skin due to damage to the pigment cells. Assumptions on the causes of it include autoimmune dysfunction, nerve damage, and self-destruction of cells (Thissen and Westerhof 1997). It can significantly impact an individual’s appearance (Komen et al. 2013). There are two methods for treating vitiligo: Q-switched laser treatment and depigmentation creams. Q-switched lasers have emerged as a promising approach for depigmenting vitiligo-affected skin. These high-energy pulsed devices emit light in very short pulses, resulting in the photoacoustic destruction of melanocytes, the cells responsible for producing pigments in the skin, destroying cells are replaced by non-pigmented cells, leading to the desired depigmentation effect (Majid and Imran 2013). Methoxyphenol is a common ingredient in depigmentation creams but can cause several (Boukari et al. 2014).

In contrast, laser treatment targets melanocytes in the skin to stimulate repigmentation (Komen et al. 2013). Studies have shown that laser-assisted depigmentation is an effective treatment for resistant vitiligo (Boukari et al. 2014), mainly when the disease is active (Komen et al. 2013). In addition, laser treatment can be used with depigmentation creams to enhance their efficacy (Thissen and Westerhof 1997). The current research demonstrates the effectiveness of laser treatment and bleaching creams. However, bleaching creams have more severe side effects than laser treatment, which only has temporary effects and has demonstrated better results; reported long-term success using laser-assisted depigmentation for resistant vitiligo. Q-switched laser depigmentation is most effective for active vitiligo and explains the effectiveness of laser treatment for vitiligo patches resistant to conventional treatment.

Side Effects of Creams and Laser Treatment  

Studies suggest the potential side effects of laser treatment and using a cream-containing methoxyphenyl to treat vitiligo. Laser Treatment (Boukari et al.2014) conducted a study to evaluate the long-term efficacy and safety of laser-assisted depigmentation for resistant vitiligo. During the sessions, temporary purplish discoloration and scabbing were the only adverse effects experienced. The discomfort experienced was manageable without needing pain relief, and reported that laser treatment was effective in depigmenting the skin, with a high success rate. Similarly,(Komen et al. 2013) investigated the effectiveness of Q-switched laser depigmentation in vitiligo and reported that laser treatment was most effective in patients with active disease. However, several temporary side effects were observed, including erythema, crusting, itch, and bullae, but no cases of scarring or infection. The (Thissen and Westerhof 1997) Laser treatment is highly effective even after just one session and has no long-lasting adverse effects.

In contrast, Cream Containing Methoxyphenol assessed the cream’s efficacy and the side effects. The cream containing methoxy phenol has been evaluated for its efficacy and side effects in a (Thissen and Westerhof 1997) study found that the cream of 4-methoxy phenol of hydroquinone can destroy the melanocytes in residual pigmentation if used daily. However, there is a risk of damaging other melanocyte-containing structures and collagen in the body. In addition, the cream may be absorbed into the bloodstream, causing side effects such as redness, burning, and itching. Similarly, (Boukari et al. 2014) side effects of cream containing methoxy phenol include skin irritation, allergic reactions, and post-inflammatory hyper-melanosis. Cryotherapy, which involves using cold to damage melanocytes, may also be used but can cause pain, redness, blisters, scabs, and possible scarring. The studies suggest that laser treatment and cream containing methoxy phenol can effectively treat vitiligo, but depending on the patient’s condition, it can be limited. Therefore, carefully evaluating the patient’s condition is necessary to determine if Q-switched laser treatment is appropriate. Monitoring this treatment’s long-term safety and efficacy is crucial for ensuring its success in treating vitiligo. Bleaching creams may have more adverse effects than laser treatment, and it is essential to consider the potential side effects of any treatment before deciding on the best course of action for vitiligo treatment.

Q-switched laser’s long-term effectiveness 

Q-switched lasers have shown effectiveness in depigmenting skin affected by vitiligo. A study (Boukari et al. 2014) assessed the long-term efficacy of Q-switched (QS) lasers in treating vitiligo. The study found that the six patients treated with QS lasers had maintenance of their results over a follow-up period of more than 48 months. Similarly, (Thissen and Westerhof 1997) investigated the effectiveness of Q-switched laser depigmentation in vitiligo. They found that this type of laser treatment was most effective in cases of active disease, with an 80% success rate in eight patients. However, (Komen et al. 2013) found that laser treatment was less effective in cases of stable disease. Only half of the 27 patients treated had their skin color return to normal by more than 75% after 13 months. Patients with active vitiligo had better results than those with stable conditions. Therefore, this treatment should be the first option, especially for small lengths that need depigmentation. However, repigmentation can be delayed, so following up on this treatment’s long-term safety and efficacy for vitiligo is crucial.

The findings from these studies suggest that Q-switched lasers can be an effective treatment option for vitiligo, particularly for patients with active disease but limited in cases of stable vitiligo. Therefore, carefully evaluating the patient’s condition is necessary to determine if Q-switched laser treatment is appropriate. Additionally, monitoring this treatment’s long-term safety and efficacy is crucial for ensuring its success in treating vitiligo. Overall, the findings of these studies suggest that Q-switched lasers can benefit the current treatment options for vitiligo. Laser-assisted depigmentation has shown promise in treating vitiligo, and its effectiveness is found in various studies using Q-switched lasers.

Conclusion

In conclusion, QS lasers have shown promising results in treating vitiligo with limited side effects compared to creams containing MethoxyPhenol. QS laser-assisted depigmentation has effectively treated resistant vitiligo, as demonstrated in a retrospective case series with long-term follow-up (Boukari et al. 2014). Additionally,(Komen et al. 2013) the QS laser depigmentation is most effective in treating active disease in vitiligo patients. Laser treatment has also been shown to be a viable option for further depigmentation in vitiligo patients, as discussed(Thissen and Westerhof 1997). Overall, laser treatment for depigmentation in vitiligo has shown to be effective and safe, making it a promising option for patients seeking treatment for this condition. Therefore, it is crucial to carefully evaluate the patient’s condition and monitor QS laser treatment’s long-term safety and efficacy in treating vitiligo. This review offers valuable insights into their effectiveness, and potential risks, which can inform clinical decision-making. It highlights the need for careful assessment of patients’ conditions and long-term safety and efficacy monitoring when using these treatments. The current research on the effects of vitiligo treatments has limitations and gaps. One limitation is the small number of studies conducted, which may limit the generalizability of the findings.

Additionally, most studies have small sample sizes, which may impact the reliability of the results. Future research should focus on larger-scale studies to provide more reliable evidence and explore the psychological and social impacts of vitiligo and its treatments on patients’ quality of life, body image, and self-esteem. Future research could explore the effect of these treatments on patients’ quality of life, body image, and self-esteem to provide an understanding of the condition. Future studies could address the limitations and gaps in the current research by conducting large-scale studies and examining the psychological and social impacts of the treatments on patients.

Literature Review Draft 

Laser Treatment for Pigmentation in Vitiligo: A Review on Its Use in Clinical Studies

Abstract: 

Vitiligo is a skin disorder that results in the loss of skin pigmentation. The condition is caused by the immune system attacking melanocytes, which are responsible for producing skin color. Vitiligo patients sometimes lose most of their melanocytes, leaving only pigmented patches that can be removed with bleaching cream that can cause damaging effects that can harm the patient’s skin. In comparison, Ruby laser treatment can be a safe and effective method to combat this condition; various treatments are available. Individuals with severe vitiligo may benefit more from using the cream containing four methoxyphenyl, while those who do not respond well to the cream may find the Q-Switched Ruby laser treatment more effective.Furthermore, the latter option has fewer long-term side effects compared to the former. Additionally, this treatment is more effective for individuals with active vitiligo than those with stable vitiligo. Overall, these treatment options can improve the quality of life for individuals with vitiligo.

Introduction: 

Vitiligo is a skin condition that causes the loss of skin color or pigment; It causes light patches on the skin because some cells that give color to the skin are eliminated. Sometimes, it causes hair to turn white or silver in affected areas. It can happen in one spot or all over the body—the immune system attacking melanocytes causes this condition, the skin cells responsible for producing pigmentation. However, there are treatments to help slow down the disease, restore skin color, and help patients regain comfort with their skin color.

Moreover, most importantly, it treats the immune system, which attacks healthy cells in the body that give skin its color. The cream contains four methoxy phenol and Q-Switched Ruby laser treatment, which shows effectiveness as a treatment for vitiligo. This treatment includes three research articles that contribute knowledge for dermatologists and patients looking for effective treatment options while learning its advantages and disadvantages. This literature review examines that those using cream containing four methoxyphenyl would be more effective in those with a more severe vitiligo spread, while for those who do not indicate an effective response to the cream, then the Q-Switched Ruby laser treatment is more effective, and has less long-term side effects than the cream. And finally, It works better for patients with active vitiligo than those with stable vitiligo.

Laser Treatment over a Cream Containing Methoxy Phenol Side Effects 

While two treatments are conducted to obtain pigmentation for the patient of vitiligo, the Q-Switched Ruby laser targets melanocytes, which are responsible for skin color, and is an effective alternative to bleaching creams containing four methoxy phenol. Using cream with a bleaching substance is an option. However, we must be careful because some creams can get into our bloodstream and hurt other parts of our body that have color. To avoid this, use a small amount of the cream. However, using the cream can cause our skin to get red, burn, and itch. The study (Thissen and Westerhof 1997) involved eight patients with vitiligo who had previously tried the cream unsuccessfully. The patients were given different amounts of laser capacity depending on their skin type, and they had to avoid sunlight for several months after the treatment.

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 results showed that five patients experienced follicular depigmentation, and four found the treatment painful. However, three patients reported positive results and remained depigmented in the treated areas. Overall, the study demonstrated the effectiveness of the treatment by laser over the cream, which has methoxy phenol and has several side effects which can become harmful to the skin if used too much. At the same time, the long-term side effect of the Q-Switched Ruby laser is examined in the Journal of the European Academy of Dermatology and Venereology(Boukari et al.2014).

Q-switched laser’s long-term effectiveness

While the Q-switched lasers have been used to depigment skin in vitiligo, there is limited data on their long-term effectiveness over the creams containing four methoxy phenol or cryotherapy. The search (Thissen and Westerhof 1997) shows that creams can only be used in small areas and can cause pain and scarring. However, Q-switched lasers are being studied to see if it is safe and effective in treating vitiligo. The study (Boukari et al.2014) looked at six patients who had not responded to other treatments of the cream mentioned. They were treated with different lasers; on average, it took two treatments to make their skin all one color. They followed up with the patients for about three years and found that most had no problems. Some patients had minor side effects like bruises and scabs, but they were only temporary. The study followed up with the patients for a few years and found that the treatment lasted for most of them. This study demonstrated that Q.S. lasers are a safe and effective method for depigmenting and 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 research only lasted at least a year/ few months. However, the British Journal of Dermatology also investigated other facts, such as the amount of vitiligo being treated on the patient’s skin (Komen et al., 2013).

Q-switched laser most effective in active vitiligo 

Even if the Q-switched lasers were found to be effective in the long term with temporary side effects and were proving to have more impact than creams, either containing four methoxy phenol or cryotherapy, the amount of vitiligo spread through the patient’s skin was examined in the research (Komen et al., 2013). They treated small spots first and checked for problems before doing more treatments. They treated up to 50-100 square centimeters of skin each time and did it every 6-8 weeks until all the affected skin was treated. They took pictures of the skin before and after treatment and asked the patients questions about their health and how they felt about the treatment. They did this with 27 patients; most had good results and were happy with the treatment. 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. Patients had vitiligo for an average of 25 years, and most had it on their faces. At treatment, vitiligo was active in 17 patients and stable in eight ). However, for two patients, they could not recall the activity of their vitiligo. With the laser treatment, some people had temporary problems like redness and itching, but no one got any bad scars or infections. One person stopped getting the treatment because it hurt too much. Some people had good results, some were okay, and some did not get much better. However, after 13 months, about half of the people’s skin color returned by more than 75%. The Q-switched laser was also a safe and effective treatment for depigmentation in patients with vitiligo. The researchers also collected patients’ information and conducted follow-ups after the study. The study found that QSR laser therapy is an effective treatment with high patient satisfaction and no long-term side effects. Moreover, patients with active vitiligo had better results than those with stable conditions. 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.

Conclusion: 

Vitiligo is a skin condition that causes loss of pigmentation in specific areas of the skin. Q-Switched Ruby (QSR) laser treatment and a cream containing methoxy phenol are options for depigmentation. However, the cream is ineffective in most cases and can cause severe side effects. The study found that QSR laser treatment is safe and effective, with high patient satisfaction and no long-term side effects. Patients with active vitiligo had better results than those with stable conditions. QSR lasers should be the first option for small areas that need depigmentation, but repigmentation may be delayed. The studies provide evidence of the success of QSR laser in its long-term effects and effectiveness on an active vitiligo condition. 

Types of  Q-switched laser Unilized 

Laser-assisted Depigmentation has emerged as a promising treatment for vitiligo. The treatment involves the selective destruction of melanocytes through laser energy (Majid and Imran 2013). According to three studies, laser-assisted Depigmentation is effective in treating vitiligo, though there are variations in the type of Q-switched laser used and the number of patients involved. To eliminate melanocytes, the Q-switched Ruby laser emits light in the red wavelength range, which penetrates deep into the skin’s dermal layer. Melanin, the color pigment in skin cells, absorbs laser light strongly at a wavelength of 694 nm (Thissen & Westerhof, 1997).While (Boukari et al.2014) utilized three QS lasers, including the 694 nm ruby laser, 755 nm Alexandrite, and 532 nm Nd: Yag laser, to treat 16 areas of customarily pigmented skin, with an average of 8.8% of the body surface area being treated. Similarly, (Komen et al. 2013) underwent treatment using the 694-nm QSR laser (Ruby Star; Asclepion Meditec, Jena, Germany). The primary clinical goal of this procedure was to achieve significant whitening by adjusting the radiant exposure accordingly to the patient skin (Boukari et al. 2014). However, it is important to note that further research is needed to fully understand the effectiveness and potential side effects of this treatment approach.

References  
Boukari F, Lacour JP, Ortonne JP, Bahadoran P, Passeron T. 2012. Laser-assisted dépigmentation
 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

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

Majid I, Imran S. 2013. Depigmentation therapy with Q-switched Nd: YAG laser in 
universal vitiligo. Journal of Cutaneous and Aesthetic Surgery. 6(2):93. doi:https://doi.org/10.4103/0974-2077.112670

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

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