What is Laser Treatment in Vitiligo?
New Generation Approaches and Efficacy Evaluations


Vitiligo is an acquired pigmentation disorder characterized by the loss of melanocyte cells responsible for melanin production, which causes skin color loss. Its incidence is around 0.5% - 1% worldwide. Vitiligo, which appears in the form of white spots (macules), can leave deep scars on patients, especially due to its social and psychological effects. Although many methods are used in the treatment of vitiligo today, the interest in laser technologies is increasing due to the successful results they have shown in treatment-resistant cases.

Laser Treatments Providing Repigmentation
Excimer Laser Treatment
In recent years, the 308 nm excimer laser has become a prominent method in the treatment of vitiligo. This laser transmits narrow-band UVB (db-UVB) light in a monochromatic and coherent manner. Thanks to its spot diameter that can vary between 14-30 mm and its flexible application arm, it can be easily applied especially on the face, neck and curved areas. The biggest advantage of the excimer laser is that it is applied only to the lesioned area and does not expose healthy skin to UV.

The mechanism of action of the excimer laser is that it stimulates melanocyte stem cells around the hair follicle, promotes melanin production, and suppresses the autoimmune process by initiating apoptosis (cell death) in T lymphocytes.

Repigmentation rates in studies have ranged from 57% to 100%. The response to treatment is better in UV-sensitive areas such as the face, neck and chest; however, the response is limited in UV-resistant areas such as the hands and feet. Individuals with skin type III and above, those with a short disease duration and patients who receive a high number of sessions achieve better results.

When the excimer laser is combined with topical corticosteroids and calcineurin inhibitors such as tacrolimus, treatment success increases. However, more studies are needed on the long-term safety of these combinations.

Low-Level Laser Therapy (LLLT)
LLLT is a technology that delivers low doses of red or near-infrared light. In the treatment of vitiligo, it supports melanin production by targeting nerve damage. It can be effective especially in segmental vitiligo, thanks to nerve growth factor and fibroblast stimulation. In studies conducted with HeNe (Helium-Neon) laser, it has been reported that 64% significant repigmentation is achieved.

Fractional Lasers
Fractional CO2 laser and Er:YAG laser are used in treatment-resistant vitiligo lesions. Although Er:YAG laser takes longer to heal, CO2 fractional laser both shortens the healing period and increases melanocyte movement with the effect of growth factors. When combined with db-UVB, repigmentation is accelerated, especially in resistant areas such as hands and feet. CO2 laser also provides successful results when used together with topical treatments.

Laser Treatments for Depigmentation
Q-switched lasers are applied to provide a more homogeneous appearance cosmetically in vitiligo patients with widespread involvement and who do not respond to treatment. In particular, Q-switched ruby ​​(694 nm) and Alexandrite (755 nm) lasers target melanin pigment and provide selective photothermolysis and melanocyte destruction.

The advantages of these lasers include rapid application, short treatment time and low scar risk. They can penetrate deeply into the tissue with high wavelengths. Q-switched Nd:YAG (1064 nm) and frequency-doubled Nd:YAG (532 nm) lasers also have similar mechanisms of action. Studies show that these lasers provide total depigmentation of 69% to 100%; however, permanence varies from person to person.

Conclusion
Laser technologies are increasingly preferred for both repigmentation and depigmentation purposes in the treatment of vitiligo. Especially in localized and treatment-resistant cases, excimer laser, LLLT in segmental vitiligo, fractional laser in resistant areas and Q-switched lasers in widespread involvement offer safe and effective options.

It should not be forgotten that vitiligo disease has individual characteristics, and laser treatments should be planned specifically for each patient. Combination treatments increase treatment success and contribute positively to the quality of life of patients.