Q-Switched Laser Depigmentation in Vitiligo
Q-Switched Laser Depigmentation in Vitiligo
Background In widespread vitiligo, when repigmentation therapies are no longer feasible, Q-switched lasers can be used to remove the remaining disfiguring pigmentation. However, little literature is available on the long-term effects of Q-switched laser treatment in patients with vitiligo, and the variables influencing the effect of treatment are unknown.
Objective To evaluate retrospectively the effectiveness, safety and patient satisfaction of Q-switched ruby (QSR) laser-induced depigmentation in widespread vitiligo.
Methods We performed a retrospective study on well-documented patients with vitiligo with widespread lesions who received depigmentation therapy with the QSR laser between 2000 and 2012 in our institute. Eligible patients were asked to visit our institute for assessment of depigmentation and to fill in a questionnaire on patient satisfaction and disease variables.
Results After a mean follow-up of 13 months, 48% of the 27 included patients showed > 75% depigmentation. Patients with active disease at the time of treatment had significantly better results than patients with stable disease (P < 0·05). Twenty-three (85%) patients were satisfied after treatment. Eighteen patients (67%) reported temporary side-effects after treatment. None of the patients reported adverse effects, such as scars or infections.
Conclusion Q-switched ruby laser therapy is effective in approximately half of patients treated; it is a safe treatment with a high patient satisfaction. Patients with active vitiligo show better results after treatment than patients with stable vitiligo. Therefore, in patients with stable vitiligo resistant to trial treatment, we advise postponing treatment until their vitiligo becomes active.
Vitiligo is a common skin disorder causing depigmented macules that can alter a patient's appearance and impair a patient's quality of life. When the majority of the skin is depigmented and repigmentation therapies are no longer feasible, depigmentation therapies can be used to remove the remaining disfiguring pigmentation. In consequence, if long-term depigmentation could be achieved in these patients with vitiligo their appearance and possibly their quality of life could be improved. To achieve this depigmentation, Q-switched lasers, cryotherapy and chemical agents are used. Q-switched lasers can result in depigmentation by selective photothermolysis of melanocytes in the remaining pigmented lesions. These lasers are reported to achieve faster depigmentation compared with chemical agents and the risk of scar formation is lower compared with cryotherapy. In small studies and case reports, Q-switched lasers have been shown to be an effective depigmentation therapy in patients with vitiligo, especially in patients with a positive Koebner phenomenon. Because of the scarcity of literature, little is known about the short- and long-term effects of treatment. The patient, disease and treatment variables that correlate with the effects of treatment are also not yet known. Therefore, the aim of our study was to evaluate retrospectively the effectiveness, safety and patient satisfaction of Q-switched laser-induced depigmentation in widespread vitiligo. Furthermore, assessment was done on the patient, disease and treatment variables that correlate with the treatment outcome, allowing better selection of patients before starting laser therapy and optimization of treatment effectiveness.
Abstract and Introduction
Abstract
Background In widespread vitiligo, when repigmentation therapies are no longer feasible, Q-switched lasers can be used to remove the remaining disfiguring pigmentation. However, little literature is available on the long-term effects of Q-switched laser treatment in patients with vitiligo, and the variables influencing the effect of treatment are unknown.
Objective To evaluate retrospectively the effectiveness, safety and patient satisfaction of Q-switched ruby (QSR) laser-induced depigmentation in widespread vitiligo.
Methods We performed a retrospective study on well-documented patients with vitiligo with widespread lesions who received depigmentation therapy with the QSR laser between 2000 and 2012 in our institute. Eligible patients were asked to visit our institute for assessment of depigmentation and to fill in a questionnaire on patient satisfaction and disease variables.
Results After a mean follow-up of 13 months, 48% of the 27 included patients showed > 75% depigmentation. Patients with active disease at the time of treatment had significantly better results than patients with stable disease (P < 0·05). Twenty-three (85%) patients were satisfied after treatment. Eighteen patients (67%) reported temporary side-effects after treatment. None of the patients reported adverse effects, such as scars or infections.
Conclusion Q-switched ruby laser therapy is effective in approximately half of patients treated; it is a safe treatment with a high patient satisfaction. Patients with active vitiligo show better results after treatment than patients with stable vitiligo. Therefore, in patients with stable vitiligo resistant to trial treatment, we advise postponing treatment until their vitiligo becomes active.
Introduction
Vitiligo is a common skin disorder causing depigmented macules that can alter a patient's appearance and impair a patient's quality of life. When the majority of the skin is depigmented and repigmentation therapies are no longer feasible, depigmentation therapies can be used to remove the remaining disfiguring pigmentation. In consequence, if long-term depigmentation could be achieved in these patients with vitiligo their appearance and possibly their quality of life could be improved. To achieve this depigmentation, Q-switched lasers, cryotherapy and chemical agents are used. Q-switched lasers can result in depigmentation by selective photothermolysis of melanocytes in the remaining pigmented lesions. These lasers are reported to achieve faster depigmentation compared with chemical agents and the risk of scar formation is lower compared with cryotherapy. In small studies and case reports, Q-switched lasers have been shown to be an effective depigmentation therapy in patients with vitiligo, especially in patients with a positive Koebner phenomenon. Because of the scarcity of literature, little is known about the short- and long-term effects of treatment. The patient, disease and treatment variables that correlate with the effects of treatment are also not yet known. Therefore, the aim of our study was to evaluate retrospectively the effectiveness, safety and patient satisfaction of Q-switched laser-induced depigmentation in widespread vitiligo. Furthermore, assessment was done on the patient, disease and treatment variables that correlate with the treatment outcome, allowing better selection of patients before starting laser therapy and optimization of treatment effectiveness.
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