Treatment of Vitiligo with an Ablative Fractional CO2 Laser Followed by Sun Exposure: A Case Report

Vitiligo is a common disease with a prevalence of about 0.5-1% for the general population. In many patients disease is resistant despite well-delineated and updated guidelines [1] on implementation methods for the many conventional and novel treatments. Various laser and light treatments, alone or combined have been shown to be effective but are available in only a few centers and require multifold sessions (UV-therapy, excimer laser or lamps, HeNe...). Sun exposure is an easy alternative in sunny regions such as the South of France. Despite their promising efficacy [2], dermabrasion or ablative laser resurfacing (e.g. Er :YAG) carry the possibility of scarring, infection and a worsening of the affliction. Fractional wounding-therapies (laser, dermaroller), by creating only microcolumns of ablation with islands of preserved-skin show a better safety profile. Microcolumns are more or less spared and more or less deep depending on the device and the settings used: density, energy, pulse duration and pulse shape for the lasers, length and diameter of the microneedles for the rollers. Recent case reports and case series have demonstrated their capacity for improvement in hypo-pigmented diseases (hypochromic scars, idiopathic guttate hypomelanosis or Vitiligo) : Firstly with nonablative fractional devices [3-5], then with ablative fractional CO2 lasers [6,7] or microneedling [8]. To our knowledge, only two prospective, randomized comparative studies have been conducted using ablative fractional CO2 laser followed by UVB phototherapy [9] or sun exposure [10] for the treatment of stable non-segmental Vitiligo. Both suggest that this combination could effectively and safely be used as an alternative method for the treatment of refractory nonsegmental Vitiligo. In the Shin et al. study on ten patients, despite moderate efficiency, mean improvement scores assessed by physicians, were significantly higher for those treated with half-body fractional CO2 laser therapy followed by NB-UVB phototherapy, as compared to those treated with NB-UVB alone (p=0.034) and, according to subjective improvements, the combined method also showed significantly greater improvements (p=0.023). In the study by Helou et al. on ten patients, enhanced improvements were reported and again greater efficacy was reported for the laser-group as compared to the control-group with sun exposure alone. Moreover in both studies there were no noticeable adverse effects such as infection, scarring, Koebner phenomenon or aggravation of Vitiligo.