Does laser treatment work for vitiligo? Treatment duration and pediatric treatment criteria

The key difference is "how broadly it is applied." The excimer precisely treats only narrow areas, while phototherapy treats broad areas or the whole body.

Both treatments share a similar principle of stimulating pigment cells with ultraviolet light of a specific wavelength. However, because the "treatment area" differs, the situations they suit also differ. To put it simply, phototherapy (NBUVB) is like "lighting up an entire room," while the excimer laser is like a "flashlight." If lesions are narrow and in a few areas, the excimer, which precisely targets only those areas like a flashlight, is efficient; if lesions are spread broadly over the body, phototherapy, which lights up the whole room, is more advantageous. Phototherapy is effective for widespread vitiligo and also helps prevent the development of new lesions and stabilize the disease in progressive vitiligo.

This is not a matter of which is "better." The key is choosing the method that fits the extent of the lesions, and depending on the condition, the two may be used together.

It is generally carried out on a schedule of 2 to 3 sessions per week. This is not a treatment that ends after one or two sessions.

Laser treatment is a treatment where "cumulative effect" matters. Because pigment cells gradually awaken through repeated stimulation, keeping to the scheduled intervals greatly affects the results. Rather than one strong stimulation, steadily building up stimulation of appropriate intensity is safer and more effective. Therefore, it is usually carried out over several months with a schedule of 2 to 3 visits per week, and if the intervals become too long in between, the stimulation may not accumulate and the response may slow.

The exact number of sessions and intensity depend on the condition of the lesions, skin type, and speed of response. If the response is good, the intensity is adjusted; if it is slow, other treatments may be combined. Therefore, the schedule is not a fixed formula from the start but is adjusted to suit each individual as progress is observed.

It works well when lesions are narrow and concentrated in specific areas. It is especially effective when limited to areas that respond well, such as the face.

Laser treatment is strong at "precise targeting," so its suitability depends on the extent and location of the lesions. Laser treatment also tends to be highly effective on the face, where there are many hair follicles, while areas like the hands and feet, which have almost no hair follicles, respond relatively poorly. This is because pigment cells awaken from hair follicles and spread. In addition, combining it with an immunomodulator ointment such as Protopic often improves the response, and it can also help people who have not responded to existing treatments.

• Well suited for → Lesions that are narrow and in a few areas, localized lesions such as on the face
• Cases where phototherapy is better → Lesions spread broadly over the whole body
• Cases where used together → Combined with a topical medication (immunomodulator) to further boost the response

In summary, whether to choose laser or phototherapy is a matter of "choosing the right tool for the lesions."

Yes, children can also receive it. It is especially suitable when the area is narrow. However, a few things are considered together.

In fact, targeted laser treatment often suits children well. This is because children commonly have localized lesions, and targeting only the lesions is less burdensome than exposing the whole body broadly to ultraviolet light. Since the excimer laser focuses only on the lesions and does not expose broad areas for long periods, it can be a suitable option for children who have difficulty with whole-body treatment, as it avoids the burden of having to stay in a whole-body phototherapy booth for a long time.

However, the following items are checked together. We assess whether the child can stay still (cooperation) during treatment, and eye and skin protection is provided for areas other than the treatment site. In children, treatment is often combined with topical medications. Since each child differs in age, lesion extent, and skin condition, pediatric treatment must be determined through individual evaluation.