Vitiligo is a disease in which the skin loses pigment due to the destruction of melanocytes (pigment-producing cells). Areas of the skin become white. The most common sites of pigment loss are body folds (such as the groin or armpits), around body openings, and exposed areas like the face or hands. Vitiligo is common; in fact, 1 to 2% of the general population has it with no predilection for age, sex, or racial background.
Its incidence is higher in people with thyroid conditions and some other metabolic diseases, but most people who have Vitiligo are in good health and suffer no symptoms other than areas of pigment loss.
Treatments for vitiligo include PUVA (oral or topical Psoralen combined with ultraviolet A phototherapy); topical corticosteroid and non-steroid treatments, and a host of other therapies including depigmentation therapy. None of these treatment methods provides a cure for the disease. Fewer than 20% of patients will experience full repigmentation with oral PUVA, and adverse effects of this treatment option include burning, nausea, erythema, lentigines, pruritus, and cataracts (Spencer et al). The use of a topical preparation prevents many of the systemic side effects of oral PUVA. However, erythema, blistering, and hyperpigmentation of surrounding skin are common complications (Ibid). In addition, the standard methods for providing light therapy (UVB or UVA) have the potential for serious side effects, require 60-150 treatments, and expose large areas of healthy skin to the radiation. Patient compliance is always less satisfactory when the treatment frequency is high. The shortcomings of systemic therapies are the serious risk of side effects. However, erythema, blistering, and hyperpigmentation of surrounding skin are common complications (Ibid). In addition, the standard methods for providing light therapy (UVB or UVA) have the potential for serious side effects, require 60-150 treatments, and expose large areas of healthy skin to the radiation. Patient compliance is always less satisfactory when the treatment frequency is high. The shortcomings of systemic therapies are the serious risk of side effects.
The Excimer laser provides a substantially improved method for delivering UVB light therapy to vitiligo patches. When compared with standard phototherapy, the 308nm xenon-chloride excimer laser has the advantage of having increased precision and the ability to deliver higher energy fluences to the target tissue in less time (Spencer et al. Treatment of vitiligo with the 308-nm excimer laser: A pilot study. J Am Acad Dermatology. 2002; 46(5): 727-731).
Published study data show that 63.7% of treated lesions achieved 50% pigmentation or greater in 20 or fewer treatments. 71.5% of the facial lesions treated had 75% pigmentation or greater, and 76.2% of treated facial lesions developed 50% pigmentation or greater. Excimer lasers deliver 308nm UVB just to the targeted patches, thereby sparing healthy tissue of exposure to the UVB. It is well tolerated and does not have the side effects of standard UVB or PUVA described above.
Moreover, the use of excimer lasers is cost-effective in relation to other treatments that would be appropriate for treating vitiligo. For example, instead of the 60 to 150 or more treatments typically required with PUVA or UVB lamp therapy, most courses of therapy require 30 treatments or less. While the excimer laser fee for treatment is higher than for PUVA or UVB, the cost of the entire course of therapy is comparable or less than other modalities. Patient compliance is also substantially improved since the entire treatment regimen can be completed in just a few months rather than over years. Each treatment session lasts less than five minutes and is absolutely painless.
The excimer laser is also useful for the treatment of unsightly white spots and uneven skin color, stretch marks, burns, or injury from trauma or laser discoloration.