Combination therapy with 308-nm excimer laser, topical tacrolimus, and short-term systemic corticosteroids for segmental vitiligo: A retrospective study of 159 patients

J Am Acad Dermatol. 2015 Jul;73(1):76-82. doi: 10.1016/j.jaad.2015.04.008. Epub 2015 May 6.

Abstract

Background: Segmental vitiligo (SV) is characterized by a unilateral and localized distribution, early onset, and stable disease after rapid progression. And SV is often associated with poor response to various treatment modalities.

Objective: We sought to evaluate the effectiveness of combination therapy with 308-nm excimer laser, topical tacrolimus, and short-term systemic corticosteroids for SV, and to search for factors associated with the treatment response.

Methods: A retrospective interventional case-series study was performed on 159 patients with SV who were treated with the combination therapy for more than 3 months.

Results: The rate of 75% or more repigmentation was 50.3% after a median treatment duration of 12.1 months; 36.5% and 13.8% of the patients showed nearly complete (75%-99%) and complete (100%) repigmentation, respectively. Multivariable analysis showed the following to be independent factors with poor response: disease duration longer than 12 months (odds ratio 0.372, 95% confidence interval 0.157-0.882, P = .025), poliosis (odds ratio 0.494, 95% confidence interval 0.247-0.988, P = .046), and plurisegmental subtype (odds ratio 0.175, 95% confidence interval 0.065-0.474, P = .001).

Limitations: This was a retrospective study.

Conclusion: The combination therapy is effective for SV. Prolonged disease duration, poliosis, and plurisegmental subtype were shown to be independent prognostic factors of poor response in patients with SV.

Keywords: excimer laser; laser; segmental vitiligo; vitiligo.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Female
  • Glucocorticoids / administration & dosage*
  • Humans
  • Infant
  • Lasers, Excimer / therapeutic use*
  • Male
  • Middle Aged
  • Prednisolone / administration & dosage*
  • Prognosis
  • Retrospective Studies
  • Tacrolimus / administration & dosage*
  • Time Factors
  • Vitiligo / drug therapy*
  • Vitiligo / surgery*
  • Young Adult

Substances

  • Glucocorticoids
  • Prednisolone
  • Tacrolimus