Combination of Fractional Carbon Di Oxide Laser with Narrow Band Ultravoilet B Therapy to induce repigmentation in stable resistant vitiligo- A split-lesional study

Context: Resistant vitiligo is challenging to treat and needs new therapeutic approaches such as combining fractional carbon dioxide (CO 2 ) laser and narrow-band ultraviolet B (NB-UVB) therapy. Aims: The study aimed to determine the efficacy and safety of combining fractional CO 2 laser and NB-UVB therapy to induce repigmentation in resistant localized vitiligo patches. Materials and Methods: In this open, prospective, split-lesional study, 40 stable resistant vitiligo patches in 30 patients were included and assessed. After an initial assessment, a few resistant patches of vitiligo were identified, and a symmetrical half of it was given two sessions of fractional CO 2 laser 1 month apart, followed by NB-UVB sessions to both sides thrice weekly for 3 months. Photographs were taken at baseline and 12 weeks, and repigmentation responses were assessed by calculating the mean percentage of improvement and mean grade of pigmentation on the fractional CO 2 laser with NB-UVB site (test) and the only NB-UVB site (control) and then compared using Wilcoxon signed-rank test, with significance determined by P value <0.05. Results: The mean grade of pigmentation (1.8±0.88) and mean surface area improvement (8.40 ± 6.82 cm 2 ) on the fractional CO 2 laser with NB-UVB site (test) were statistically better than the mean grade of pigmentation (1.27 ± 0.71) and mean surface area improvement (5.37 ± 6.76 cm 2 ) on the NB-UVB site. A better grade of pigmentation was noted over sun-protected areas with fractional CO 2 and NB-UVB therapy, while NB-UVB therapy fared better in sun-exposed areas. Conclusions: Fractional CO 2 laser with NB-UVB therapy is an effective treatment in resistant vitiligo patches, especially for sun-protected areas.