Treatment of resistant acral vitiligo with fractional Er:YAG laser

  • Muhsin Al-Dhalimi Department of Dermatology, Faculty of Medicine, University of Kufa, Iraq.
  • Haider Al-Sabak Department of Dermatology, Faculty of Medicine, University of Kufa, Iraq.
  • Aula Hussain Department of Dermatology, Karbala Health Directorate, Ministry of Health, Iraq.


Objectives To detect the results of treatment of refractory acral vitiligo by combination of fractional erbium-YAG (Er:YAG) 2940 nm laser andnarrow band-ultraviolet B (NB-UVB) in comparison with NB-UVB alone.Methods Thirty four patients who had generalized, stable (6 months or more) with resistant acral vitiligo were enrolled. The predominantlyaffected limbs, lower or upper, were treated with both laser and NB-UVB, while the less predominantly affected limbs were treated withNB-UVB alone. During the treatment period, the patients were seen every 4 weeks regularly.Results The response rate in areas treated with both fractional Er:YAG laser and NB-UVB was as follows: Four patients (13.3%) had goodresponse, six patients (20%) had moderate response and seven patients (23.3%) had poor response and 13 patients (43.3%) had noresponse. The statistical analysis showed a significant response (P-value <0.001).Conclusion Combination therapy is safe and more effective in the treatment of acral vitiligo than NB-UVB monotherapy.
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1. Sandoval-Cruz M, García-Carrasco M, Sánchez-Porras R, Mendoza-Pinto C, Jiménez-Hernández M, Munguía-Realpozo P, et al. Immunopathogenesis of vitiligo. Autoimmun Rev. 2011;10:762–765.
2. Bhatnagar A, Kanwar AJ, Parsad D, De D. Comparison of systemic PUVA and NB-UVB in the treatment of vitiligo: an open prospective study. J Eur Acad Dermatol Venereol. 2007;21:638–642.
3. Esmat SM1, El-Tawdy AM, Hafez GA, Zeid OA, Abdel Halim DM, Saleh MA, et al. Acral lesions of vitiligo: why are they resistant to photochemotherapy? J Eur Acad Dermatol Venereol. 2012;26:1097–1104.
4. Anbar TS, Westerhof W, Abdel-Rahman AT, Ewis AA, El-Khayyat MA. Effect of one session of ER:YAG laser ablation plus topical 5Fluorouracil on the outcome of short-term NB-UVB phototherapy in the treatment of non-segmental vitiligo: a left–right comparative study. Photodermatol Photoimmunol Photomed. 2008;24:322–329.
5. Zachary CB. Modulating the Er:YAG laser. Lasers Surg Med. 2000;26:223–226.
6. Sami Y. Efficacy of PUVA therapy vs NB-UVB therapy. ARC Dermatol. 2007;143:578–584.
7. Vachiramon V, Chaiyabu tr C, Rattanaumpawan P, Kanokrungsee S. Effects of a preceding fractional carbon dioxide laser on the outcome of combined local narrowband ultraviolet B and topical steroids in patients with vitiligo in difficult-to-treat areas. Lasers Surg Med. 2016;48:197–202.
8. Radmanesh M, Sohrabian N, Radmanesh R. Repigmentation of vitiliginous facial area after Q-switched Nd-YAG laser therapy for depigmentation: is it a case of true reverse Koebner phenomenon in vitiligo? Iran J Dermatol. 2013;16:159–161.
9. Anbar T, Westerhof W, Abdel-Rahman A, El-Khayyat M, El-Metwally Y. Treatment of periungual vitiligo with erbium-YAG-laser plus 5-flurouracil: a left to right comparative study. J Cosmet Dermatol. 2006 5:135–139.
10. Bayoumi W, Fontas E, Sillard L, Le Duff F, Ortonne JP, Bahadoran P, et al. Effect of a preceding laser dermabrasion on the outcome of combined therapy with narrowband ultraviolet B and potent topical steroids for treating nonsegmental vitiligo in resistant localizations. Br J Dermatol. 2012;166:208–211.
11. Li L, Wu Y, Li L, Sun Y, Qiu L, Gao XH, et al. Triple combination treatment with fractional CO2 laser plus topical betamethasone solution and narrowband ultraviolet B for refractory vitiligo: a prospective, randomized half-body, comparative study. Dermatol Ther. 2015;28:131–134.
12. Shin J, Lee JS, Hann SK, Oh SH. Combination treatment by 10,600 nm ablative fractional carbon dioxide laser and narrowband ultraviolet B in refractory non segmental vitiligo: a prospective, randomized half-body comparative study. Br J Dermatol. 2012;166:658–661.
How to Cite
AL-DHALIMI, Muhsin; AL-SABAK, Haider; HUSSAIN, Aula. Treatment of resistant acral vitiligo with fractional Er:YAG laser. Journal of Contemporary Medical Sciences, [S.l.], v. 4, n. 4, dec. 2018. ISSN 2413-0516. Available at: <>. Date accessed: 20 june 2019.