Combination Fractional Carbon Dioxide Laser, Topical Phenytoin Shows Promise Against Vitiligo

A combination fractional CO₂ laser used in combination with topical phenytoin has shown efficacy in treating vitiligo, not only in the upper extremities and trunk, but also acral areas.

A team, led by Hajar Abasifar, Skin Research Center, Shahid Beheshti University of Medical Sciences, evaluated the effect of fractional CO₂ laser in combination with topical phenytoin.

Vitiligo Treatments

Developers have created several different treatment modalities for vitiligo including corticosteroids, calcineurin inhibitors, vitamin D analogous, and topical phenytoin.

One emerging treatment is a combination therapy utilizing fractional CO₂ laser with different topical agents to enhance treatment response.

In the study, the investigators examined 25 patients between 18-59 years. The mean age of the patient population was 31.12 years.

The Patients

Each participant had non-segmental stable vitiligo and insufficient response to at least one-year treatment with a monotherapy using topical corticosteroids, calcineurin inhibitors, and/or NB-UVB phototherapy.

Each patient in the study was treated with a combination fractional CO₂ laser (10600 nm, pulse energy 30 to 50 mJ, MIXEL, South Korea, Rating: 220VAC, 3A, 50/60Hz) monthly for 6 months. They also applied phenytoin 1% cream twice daily.

The investigators conducted photography before and after treatment with Wood’s lamp and calculated the severity of disease using VASI score and compared the scores before and after treatment.

The Scores

The results show a mean VASI score prior to treatment of 0.55. This increased to 1.97 (P <0.001) at the 6 month mark.

The investigators also divided the patients into 3 groups based on the vitiligo subtype—acral, upper extremities, and trunk.

They measured VASI scores in each group and found a before score of 0.50 and an after score of 1.49 in the acral area, a before score of 0.45 and a after score of 2.04 in the upper extremities group, and a before score of 0.79 and an after score of 3.39 in the trunk score.

“This study revealed that combination therapy with phenytoin and fractional CO₂ laser is effective in treatment of vitiligo not only in the upper extremities and trunk, but also interestingly in the acral areas,” the authors wrote

The study, “Evaluation of Combination use of phenytoin Cream 1% and Fractional CO2 laser in Treatment of Stable Non-Segmental Vitiligo: A Pilot Study,” was published online in Dermatologic Therapy.