Question 1

Is a higher energy excimer laser more effective?

Accepted Answer

Not necessarily. For facial vitiligo, treatment with a low dose can achieve a repigmentation rate similar to that of the standard dose. The excimer laser is a treatment that selectively delivers 308 nm ultraviolet light to vitiligo lesions, stimulating the proliferation and migration of melanocytes. In general, mild erythema after treatment is considered an appropriate response, but strong energy that causes the skin to turn red is not always necessary. In a randomized controlled trial comparing low-dose and standard-dose treatment in patients with facial vitiligo, the repigmentation rates were 86.1% and 86.9%, respectively, showing little difference. In addition, the proportion of patients who achieved 75% or more repigmentation was 83.4% in both the low-dose and standard-dose groups. In contrast, in the standard-dose group, 44.4% developed perilesional hyperpigmentation, and 22.2% experienced erythema or pain lasting more than 3 days, whereas these side effects were not observed in the low-dose group. This means that for facial vitiligo, low-dose treatment is possible, maintaining efficacy while reducing erythema and hyperpigmentation.

Question 2

Is it more effective to use the excimer laser together with Protopic ointment?

Accepted Answer

Yes. Using them together can increase the treatment success rate compared to excimer laser monotherapy. Calcineurin inhibitors, including Protopic ointment, modulate the immune response involved in vitiligo and aid the proliferation and migration of melanocytes. In a comprehensive analysis of 8 randomized controlled trials conducted by our research team, combining a calcineurin inhibitor with the excimer laser approximately doubled the treatment success rate and reduced the risk of treatment failure by more than half. In particular, combination therapy from the early stages of treatment also helped accelerate the repigmentation rate. Therefore, even if Protopic ointment feels sticky or causes a burning sensation initially, it is important to use it consistently together with the excimer laser rather than stopping it arbitrarily to enhance treatment efficacy.

Question 3

On which body areas is the excimer laser most effective?

Accepted Answer

A good response is seen on the face and neck, while the hands and feet are relatively more difficult to treat. In a study analyzing 979 patients, approximately 41% of patients with facial vitiligo achieved 75% or more repigmentation, whereas only about 9% did on the hands and feet. Therefore, if the response to the excimer laser is insufficient, it may not be appropriate to simply keep increasing the energy. Especially in areas like the hands and feet, which inherently have a low treatment response, it is important to distinguish whether the energy level is insufficient or whether the lesion itself has limitations that cannot be overcome with laser treatment alone.

Question 4

Do I need to continue applying ointment after treatment is successfully completed?

Accepted Answer

Yes. Maintenance treatment after repigmentation helps reduce the risk of recurrence. Vitiligo is a chronic condition that can reappear even after successful treatment. Although the recurrence rate within one year after treatment is reported to be about 40%, studies have shown that consistent use of Protopic ointment on previously affected areas can lower the recurrence risk to approximately 10%. Therefore, rather than stopping all treatment as soon as color returns, it is important to consider maintenance therapy to prevent recurrence as part of the overall treatment process.

Question 5

What should I be careful about before and after excimer laser treatment?

Accepted Answer

Before treatment, check the timing of sunscreen and ointment use; after treatment, check for excessive redness or blisters. Before treatment: ① Remove sunscreen. If sunscreen absorbs 308 nm ultraviolet light, the laser energy may not be fully delivered to the skin. It is recommended to treat the area with clean skin. ② Do not apply Protopic ointment right before treatment. Applying it right before the laser may cause light reflection due to the greasy formulation. Using it after treatment is fine. After treatment: ① If severe redness or blisters occur, apply a cold compress. If the treated area becomes excessively red or develops pain or blisters, cooling the skin with a cold compress can help. ② Maintain a consistent treatment interval. For excimer laser, regular treatment 2 to 3 times per week can generally lead to faster repigmentation. ③ Treatment is also possible for children. Since the excimer laser can selectively treat only the vitiligo areas without needing to enter a whole-body phototherapy booth, it can be applied to pediatric patients. Ultimately, excimer laser treatment is not a therapy where simply using a high energy level yields better results. It is important to find the appropriate dose, combine it with Protopic ointment, consider the treatment response by area, and manage the risk of recurrence even after repigmentation.

Vitiligo Excimer Laser: How Should You Receive It for Different Results?

Is a stronger excimer laser dose more effective?

Does combining excimer laser with Protopic ointment improve results?

Which body areas respond best to excimer laser treatment?

Do I need to keep applying ointment after treatment is complete?

What should I watch out for before and after excimer laser treatment?

References