Combination therapy of carbon dioxide laser with topical halometason cream and 308 nm excimer laser for the treatment of vitiligo: an optimized combined treatment protocol

The treatment for refractory non-segmental vitiligo (RNSV) remains unsatisfactory, particularly for acral vitiligo (AV) and phototherapy platform-stage vitiligo (PPV), despite the numerous treatment modalities available for vitiligo. The efficacy of a triple combination therapy comprising a 308-nm excimer lamp, a fractional CO2 laser, and a topical formulation was examined in this study. A better topical formulation and fractional CO2 laser settings were tested on 64 fresh human foreskin samples. At 15 mJ pulse energy and 10% coverage, the fractional CO2 laser and topical halometasone cream achieved a more widespread and consistent distribution with minimal side effects. The clinical trial included 98 individuals with 158 RNSV lesions. A total of 46 patients with 98 AV lesions and 52 with 60 PPV lesions were randomly assigned to T and C groups. T groups received fractional CO2 laser, plastic-wrapped halometasone cream, and 308-nm excimer lamp therapy. The C group received 308-nm excimer lamp, topical calcineurin inhibitor and halometasone cream (without fractional CO₂ laser). A twice-weekly 308-nm excimer lamp therapy was used for three months. In the T group of PPV, 50% of lesions were successful at the conclusion of the research, while only 10% of lesions in the C group of PPV were successful (P ≤ 0.000). Success was attained by 8.16% of lesions in the T group of AV, while only 6.12% of lesions in the C group of AV were successful (P = 0.425). The PPV is definitively influenced by the tripartite combination therapy of a 308-nm excimer lamp, topical halometasone cream, and fractional CO2 laser. The treatment duration of PPV can be shortened and the phototherapy platform stage can be avoided. Conversely, the combination treatment did not yield satisfactory results for vitiligo in the acral region.