Heal House Vitiligo Research 39 · Letter
Does vitiligo excimer laser need to be applied strongly enough to cause redness for good results?
Suberythemic and erythemic doses of a 308-nm excimer laser treatment of stable vitiligo in combination with topical tacrolimus: A randomized controlled trial.
Final review
In short
We compared excimer laser applied with enough energy to cause the skin to turn red versus excimer laser applied gently enough not to cause redness. In both cases, Protopic ointment was also applied. This trial aimed to find a balance between safety and effectiveness.
"Doctor, since I'm doing it anyway, please apply it strongly so I can get better quickly." This is a common request from patients receiving excimer laser treatment. However, applying it strongly can cause the skin to become red or develop blisters. Stronger is not necessarily better. So I directly compared a low dose that does not cause redness with a high dose that does cause redness. In both cases, Protopic ointment was applied together, and patients were randomly assigned to compare which approach was better.
Q1 Is it better to get a strong dose that makes the skin red, or a milder one?
Applying it strongly is not always better. Finding the balance between efficacy and safety is more important. Increasing the laser dose to the point of skin redness can push repigmentation further. However, it also increases irritation such as burning or blistering. Conversely, a low dose that does not cause redness is safer with less irritation. But there is concern that the effect may be weaker. So I tested whether applying Protopic ointment, which helps repigmentation, could compensate for the weakness of the low dose. The purpose of this study was to find a way to maintain efficacy while putting less strain on the skin by using both treatments together.
Closing remarks
Each patient's skin condition and tolerance to irritation are different. Therefore, it is better to adjust the laser dose individually rather than using a fixed dose. This study was an attempt to find a balance between safety and efficacy by using Protopic ointment together, instead of the conventional belief that "stronger is better." In my actual practice, I carefully determine the dose while monitoring both redness and efficacy.
