Efficacy And Related Factors Of 308-nm Excimer Laser In Treatment Of 979 Vitiligo Patients

Background:Vitiligo is a common dispigmentary skin disorder.The exact pathogenesis of the disease is yet unclear,and it may be associated with autoimmune, genetic,oxidative stress,neuronal mechanisms,melanocyte destruction factors.Vitiligo occurs in the exposed areas,impacting on the aesthetics and bringing psychological burden to patients.With the study of vitiligo and development of medical technology,a variety of approaches have been proposed,including local or systemic corticosteroids,topical vitamin D3 derivative,immunomodulators,light therapy,surgery.Light therapy is one of the most safe and effective method.NB-UVB and PUVA have been used in the treatment of vitiligo decades.308-nm excimer laser is a new method,belonging to UVB category,which was first used in treatment of psoriasis,pigmentation after irradiation in lesions,so some scholars proposed for the treatment of vitiligo.Several studies found that 308-nm excimer laser in the treatment of vitiligo was quick action,effectively and few side effects.Objective:To investigate the efficacy and related factors of 308-nm excimer laser in Chinese vitiligo patients.Methods:Retrospective study,a total of 979 vitiligo patients(3478 lesions) who received308-nm excimer laser were recruited from the vitiligo clinic of Shandong Provincial Hospital of Dermatology & Venereology from April,2012 to April 2014,one time a week.Before treatment,initial dose depending on the MED value and the anatomical area.The following treatment dose was adjusted by reaction after each treatment.Efficacy was evaluated at the end of treatment by two independent dermatologists based on the before and afterphotographs.Results:979 patients(3478 lesions)completed the study.Mean grade of repigmentation was 2.29,44.22%(n:1538) showed less than 25% repigmentation, 16.27%(n:566) showed26-50% repigmentation,5.95%(n:207) showed 51-75% repigmentation and 33.55%(n:1167)showed more than 76% repigmentation.The repigmentation of facial lesions was better than lesions located elsewhere(P<0.0001),lesions on hands and feet showed poor repigmentation(P<0.0001).While,the best response was noted in the periorbital region(P<0.0001).The degree of repigmentation was increased with increasing times of treatment(P<0.001),21-25 times of treatment appeared a plateau.The degree of repigmentation in shorter disease duration(<24 months) was siginificantly higher than the longer disease duration(>24months)(P<0.001).The degree of repigmentation in younger was relatively high(P<0.001).The degree of repigmentation in irregular shape lesions was higher than the regular shape lesions(P<0.001).Poliosis accompanied lesions were more likely resistant to treatments.Conclusion:The treatment of vitiligo with 308 nm excimer laser is safe and effective in Chinese vitiligo patients.And the clinical response correlated with factors such as age,anatomical area,shape of the lesion,disease duration,treatment times and poliosis.