The Efficacy of a Gain-Switched 311-nm Titanium:Sapphire Laser in the Treatment of Vitiligo: A Pilot Study of 14 Patients | Dermatology | JAMA Dermatology | JAMA Network
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Figure.  Patient With Vitiligo Treated With a Gain-Switched 311-nm Titanium:Sapphire Laser
Patient With Vitiligo Treated With a Gain-Switched 311-nm Titanium:Sapphire Laser

A, Patient 2 had vitiligo on the cheek before treatment. B, After 30 treatment sessions, the repigmentation was excellent (75%-99% repigmentation).

Table.  Treatment Parameters and Clinical Outcomes of 14 Patients With Vitiligo
Treatment Parameters and Clinical Outcomes of 14 Patients With Vitiligo
1.
Florez-Pollack  S, Jia  G, Zapata  L  Jr,  et al.  Association of quality of life and location of lesions in patients with vitiligo.  JAMA Dermatol. 2017;153(3):341-342.PubMedGoogle ScholarCrossref
2.
Hamzavi  IH, Lim  HW, Syed  ZU.  Ultraviolet-based therapy for vitiligo: what’s new?  Indian J Dermatol Venereol Leprol. 2012;78(1):42-48.PubMedGoogle ScholarCrossref
3.
Yones  SS, Palmer  RA, Garibaldinos  TM, Hawk  JL.  Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UV-A therapy vs narrowband-UV-B therapy.  Arch Dermatol. 2007;143(5):578-584.PubMedGoogle ScholarCrossref
4.
Baltás  E, Nagy  P, Bónis  B,  et al.  Repigmentation of localized vitiligo with the xenon chloride laser.  Br J Dermatol. 2001;144(6):1266-1267.PubMedGoogle ScholarCrossref
5.
Zhang  XY, He  YL, Dong  J, Xu  JZ, Wang  J.  Clinical efficacy of a 308 nm excimer laser in the treatment of vitiligo.  Photodermatol Photoimmunol Photomed. 2010;26(3):138-142.PubMedGoogle ScholarCrossref
6.
Choi  SY, Oh  CT, Kwon  TR,  et al.  Gain-switched 311-nm Ti:sapphire laser might be a potential treatment modality for atopic dermatitis.  Lasers Med Sci. 2016;31(7):1437-1445.PubMedGoogle ScholarCrossref
Research Letter
October 2017

The Efficacy of a Gain-Switched 311-nm Titanium:Sapphire Laser in the Treatment of Vitiligo: A Pilot Study of 14 Patients

Author Affiliations
  • 1Department of Dermatology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
JAMA Dermatol. 2017;153(10):1055-1056. doi:10.1001/jamadermatol.2017.2175

Vitiligo is a common acquired depigmentation disorder of the skin that has major effects on a patient’s quality of life.1 Laser treatment has an advantage in treating vitiligo in a targeted manner and is a reasonable treatment option for localized vitiligo.2 Recently, a gain-switched 311-nm titanium:sapphire laser (TSL) using solid medium was developed based on the peak spectrum of narrow-band UV-B. In this study, we evaluated the efficacy and safety of the 311-nm TSL in the treatment of vitiligo.

Methods

This open-label trial enrolled 14 patients with nonsegmental vitiligo who had lesions on the face and neck between June 1, 2016, and January 31, 2017. The vitiligo lesions were treated twice a week using a gain-switched 311-nm TSL (Pallas; Laseroptek). The treatment dose started at 300 mJ/cm2 and was increased by 50 mJ/cm2 in each subsequent session until posttreatment erythema occurred. Subsequently, the dose was kept constant at the minimal erythemal dose. Topical tacrolimus ointment, 0.1%, was applied concurrently to all lesions throughout the treatment period. Sun protection was recommended. Clinical photographs were obtained at baseline and every other week. Two dermatologists (J.H.L. and Y.S.J.) independently compared the photographs of the final follow-up with those at baseline and assessed the level of repigmentation using a quartile grading scale (no repigmentation, 0%; mild, 1%-24%; moderate, 25%-49%; good, 50%-74%; excellent, 75%-99%; complete, 100%). All patients signed informed consent, and the study was approved by the Ethics Committee of the Catholic Medical Center Office of Human Research Protection.

Results

The median number of treatment sessions was 23 (range, 13-47); the median treatment duration was 3.7 (range, 1.8-6.2) months; the median cumulative dose was 11 850 (range, 4400-24 450) mJ/cm2; and the maximum dose was 650 (range, 400-900) mJ/cm2 (Table).

Eleven patients (79%) showed excellent to complete repigmentation after medians of 21 (range, 13-39) treatments and 3.7 (range, 1.8-6.1) months (Figure). The remaining 3 patients had good (n = 2) or moderate (n = 1) repigmentation. Repigmentation began after a median of 5 treatments (range, 4-9). A combined pattern of marginal and perifollicular repigmentation (6 [43%]) was predominant, followed by perifollicular (4 [29%]), marginal (3 [21%]), and diffuse (1 [7%]) patterns. Five patients (36%) experienced persistent erythema lasting more than 48 hours, but this improved spontaneously after 3 to 4 days. No serious adverse effects stopped the treatments.

Discussion

Although narrow-band UV-B phototherapy is the most widely used treatment modality for patients with vitiligo, it is associated with unnecessary UV exposure to normal skin.3 Because a majority of patients have limited involvement of their body surface, targeted phototherapy including a 308-nm xenon chloride excimer laser (EL) has been considered the treatment of choice for localized vitiligo.4

In this study, we observed a marked response using a 311-nm TSL to treat patients with nonsegmental vitiligo on the face and neck. The initial response was fast, and the overall efficacy of the TSL treatment was comparable to that reported for EL treatment.5 The therapeutic mechanism of TSL would involve immune modulation and melanocyte stimulation, as in narrow-band UV-B and EL treatment.6 The 311-nm TSL has several advantages. It does not require the periodic gas charging that is crucial for EL maintenance. In addition, the 311-nm wavelength of TSL can penetrate deeper than the 308-nm wavelength of EL. The gain-switched 311-nm TSL is a promising option for treating vitiligo. Further research is needed, including clinical trials comparing EL and TSL.

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Article Information

Corresponding Author: Gyong Moon Kim, MD, PhD, Department of Dermatology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon 16247, Korea (kim846@gmail.com).

Accepted for Publication: May 11, 2017.

Published Online: July 19, 2017. doi:10.1001/jamadermatol.2017.2175

Author Contributions: Drs Bae and Lee had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Bae and Lee contributed equally to this work.

Study concept and design: Bae, Lee.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Bae, Lee.

Critical revision of the manuscript for important intellectual content: Bae, Jung, Kim.

Statistical analysis: Bae.

Obtained funding: Bae.

Administrative, technical, or material support: All authors.

Supervision: Bae, Kim.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported in part by the St. Vincent’s Hospital, Research Institute of Medical Science (SVHR-2017-02).

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Florez-Pollack  S, Jia  G, Zapata  L  Jr,  et al.  Association of quality of life and location of lesions in patients with vitiligo.  JAMA Dermatol. 2017;153(3):341-342.PubMedGoogle ScholarCrossref
2.
Hamzavi  IH, Lim  HW, Syed  ZU.  Ultraviolet-based therapy for vitiligo: what’s new?  Indian J Dermatol Venereol Leprol. 2012;78(1):42-48.PubMedGoogle ScholarCrossref
3.
Yones  SS, Palmer  RA, Garibaldinos  TM, Hawk  JL.  Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UV-A therapy vs narrowband-UV-B therapy.  Arch Dermatol. 2007;143(5):578-584.PubMedGoogle ScholarCrossref
4.
Baltás  E, Nagy  P, Bónis  B,  et al.  Repigmentation of localized vitiligo with the xenon chloride laser.  Br J Dermatol. 2001;144(6):1266-1267.PubMedGoogle ScholarCrossref
5.
Zhang  XY, He  YL, Dong  J, Xu  JZ, Wang  J.  Clinical efficacy of a 308 nm excimer laser in the treatment of vitiligo.  Photodermatol Photoimmunol Photomed. 2010;26(3):138-142.PubMedGoogle ScholarCrossref
6.
Choi  SY, Oh  CT, Kwon  TR,  et al.  Gain-switched 311-nm Ti:sapphire laser might be a potential treatment modality for atopic dermatitis.  Lasers Med Sci. 2016;31(7):1437-1445.PubMedGoogle ScholarCrossref
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