Heal House Vitiligo Research 01 · Original Article
Segmental vitiligo, which is considered difficult to treat—how much improvement can combination therapy achieve?
Combination therapy with 308-nm excimer laser, topical tacrolimus, and short-term systemic corticosteroids for segmental vitiligo: A retrospective study of 159 patients.
Last reviewed
In short
Three treatments were used together in 159 patients with segmental vitiligo. More than half (50.3%) achieved 75% or greater repigmentation.
Segmental vitiligo appears as strip-like patches on one side of the body. It usually develops at an early age and is known to respond poorly to many treatments. As a result, many patients in the clinic would lose hope in advance, saying, "Isn't it a disease that doesn't get better anyway?" Is that really the case? I have been using a combination of excimer laser, Protopic ointment, and a short course of oral steroids for this difficult type. I reviewed the records of 159 patients to see what the actual results were.
Q1 How much did combination therapy help?
Of the 159 patients treated, 50.3% achieved 75% or more repigmentation. That is over half. The median treatment duration was 12.1 months. This includes patients who had almost complete repigmentation (75–99%) and those with complete repigmentation (100%). For a type known to be difficult to treat, these results are by no means poor. The table below shows the percentages by degree of repigmentation.
Degree of repigmentation after combination therapy (159 patients)
| Degree of repigmentation | Proportion of patients |
|---|---|
| Complete (100%) | 13.8% |
| Almost complete (75–99%) | 36.5% |
| 75% or more (total) | 50.3% |
Q2 Who saw less improvement?
Response was slower in three cases: when the disease had been present for a long time, when there were white hairs (leukotrichia) within the patches, or when there were multiple segments. If the disease duration exceeded 12 months, the likelihood of good improvement fell to about one-third. The presence of white hairs reduced it to about half. Multiple segments decreased it to less than one-fifth. In other words, starting treatment as early as possible is key to a good outcome.
Factors associated with slower response (lower likelihood of good response)
| Factor | Odds ratio (OR) | In simple terms |
|---|---|---|
| Disease duration > 12 months | 0.372 | Likelihood of good improvement approximately one-third |
| Leukotrichia (white hairs) | 0.494 | Approximately half |
| Plurisegmental (multiple segments) | 0.175 | Less than one-fifth |
Q3 So what should you do?
I recommend not giving up in advance just because it is segmental vitiligo, and starting treatment as early as possible. This is because the longer the condition is left untreated, the poorer the response. Combining multiple treatments early on and pursuing them aggressively offers a better chance. If there are white hairs or multiple segments, treatment may take longer. It is important to be aware of this and remain patient. Although this type is known to be difficult to treat, over half of the patients showed significant improvement.
Closing remarks
Segmental vitiligo can also improve significantly in over half of patients if treated consistently with a well-combined regimen. This is demonstrated by the real-world experience of 159 patients. We also identified who tends to respond more slowly. This has allowed us to share realistic expectations with patients before starting treatment. Changing the narrative from "it won't work anyway" to "it is worth trying"—that is the greatest gift this study has given me.
