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). 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 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 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,
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.
Excimer
laser is also useful for treatment of unsightly white spots and
uneven skin color, stretch marks, burns or injury from trauma
or laser discoloration.
