Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study

Mostafa Kadry, Abeer Tawfik, Noha Abdallah, Ashraf Badawi, Hisham Shokeir, Mostafa Kadry, Abeer Tawfik, Noha Abdallah, Ashraf Badawi, Hisham Shokeir

Abstract

Purpose: The aim of this study was to assess the efficacy of platelet-rich plasma (PRP) vs combined fractional CO2 (Fr: CO2) laser with PRP in the treatment of stable nonsegmental vitiligo (NSV) lesions.

Patients and methods: This prospective, randomized, intrapatient, comparative controlled study was conducted between June 2014 and June 2016 at National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt. Thirty NSV patients were treated with PRP, Fr: CO2 laser, and combined Fr: CO2 laser with PRP. Intrapatient lesions were divide randomly into four groups. Each group was treated by one modality. The fourth group served as a control.Patients received six treatment sessions with 2-week interval for 3 months and were followed up after 3 months.

Results: A highly significant reduction was demonstrated through vitiligo analysis by computer-assisted grid (VACAG) in the combined Fr: CO2 laser with PRP and in the PRP only groups than other groups. These results were confirmed by mean improvement score by physician (MISP) and by VAS with no statistical difference between them. The combined Fr: CO2 laser with PRP group showed minimal side effects. Regardless of the modalities, better improvement was seen in the trunk than the face, extremities, and acral lesions with significant reduction in all regions. Face showed maximum response with combined Fr: CO2 laser with PRP. Trunk showed higher response with PRP. Upper limbs showed highest response with combined Fr: CO2 laser with PRP. Lower limbs showed the highest improvement with Fr: CO2 laser.

Conclusion: According to our study, combined Fr: CO2 laser with PRP achieved superior repigmentation than intradermal (ID) PRP. However, Fr: CO2 alone showed poor improvement. Combined ablative Fr: CO2 laser and PRP therapy followed by sun exposure could be used effectively and safely to treat refractory NSV.

Keywords: fractional carbon dioxide laser; melanoblasts; nonsegmental vitiligo; platelet-rich plasma; refractory vitiligo; stem cells; undifferentiated stem cell; vitiligo.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Point counting: example grid for vitiligo lesion. The total area of the lesion was estimated by multiplying 0.1 cm2 by the number of points. (B) Digital planimetry technique: calculation of changes in the vitiligo patch size by AutoCAD 2016, version 20.1. Abbreviation: PRP, platelet-rich plasma.
Figure 2
Figure 2
Variable results of improvement of vitiligo. Notes: (A) A 22-year-old female patient, skin type III with 3 years duration of vitiligo lesions. Pretreatment and posttreatment images showing lower left chin treatment with combination of Fr: CO2+ PRP. (B) A 38-year-old female patient, skin type III with 12 months duration of vitiligo lesions. Pretreatment and posttreatment images showing upper forehead treatment with PRP. (C) A 21-year-old female patient, skin type II with 26 months duration of vitiligo lesions. Pretreatment and posttreatment images showing right elbow treatment with CO2. (D) A 26-year-old male patient, skin type III with 14 months duration of vitiligo lesions. Pretreatment and posttreatment images showing back with PRP+CO2.
Figure 3
Figure 3
Relationship between degree of improvement and sites in all groups together. Abbreviations: LL, lower limb; UL, upper limb.
Figure 4
Figure 4
H&E staining and HMB45. Notes: (A) Absence of melanin pigmentation (H&E, ×200) before treatment. (B) Prominent melanin pigmentation (H&E, ×200) after treatment with PRP. (C) Prominent melanin pigmentation (H&E, ×200) after treatment with CO2+PRP. (D) Weak melanin expression (H&E, ×200) after treatment with CO2 alone. (E) Mild expression of HMB45 (PAP, ×200) before treatment. (F) Marked expression of HMB45 (PAP, ×200) after treatment with PRP. (G) Marked expression of HMB45 (PAP, ×200) after treatment with CO2+PRP. (H) Moderate expression of HMB45 (PAP, ×200) after treatment with CO2. Abbreviation: PAP, Papanicolaou stain; PRP. platelet-rich plasma

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