What is Vitiligo Treatment?
Vitiligo is a pigmentation disorder that develops due to epidermal melanocyte loss.

Its incidence is 0.5-1%.

Clinically, it progresses with white macules and graying of the hair.

It has great psychosocial effects.

In its etiopathogenesis: genetic predisposition, autoimmunity, oxidative stress, neural and viral factors are blamed.

Classical Treatments
Topical corticosteroids, calcineurin inhibitors, vitamin D analogs, phototherapy, grafting, melanocyte transplantation, depigmentation are used.

However, conventional treatments do not always provide sufficient success.

LASER TREATMENTS
1. Excimer Laser (308 nm)
Provides monochromatic UVB light.

Spot diameter 14–30 mm.

Effective in UV-sensitive areas such as the face and neck.

Treatment is applied 2–3 times per week.

Moderate erythema is considered a treatment dose.

Mechanism of action: Melanocyte proliferation, T lymphocyte apoptosis.

Success rate increases with combination treatments (topical steroids, tacrolimus).

Side effects: Erythema, edema, burning; costly in large areas.

2. Low-Level Laser Therapy (LLLT)
Low-dose red or near-infrared light is used (e.g. HeNe laser – 632 nm).

Supports cell regeneration.

Effective in segmental vitiligo.

Repigmentation rates of up to 60% have been reported.

Its effect is related to nerve growth factor release and melanocyte activation.

3. Fractional Lasers
Devices such as fractional CO₂ laser, Er-YAG laser are used.

It is especially effective in treatment-resistant areas such as hands/feet.

Mechanism of action: Cytokine release, growth factors, melanocyte migration.

Effectiveness increases with combination treatments (e.g. with db-UVB).

4. Q-Switched Lasers (For Depigmentation)
Q-Switched Ruby (694 nm), Alexandrite (755 nm), Nd:YAG (532/1064 nm) lasers.

Preferred in cases with widespread involvement (> 60%).

Provides permanent depigmentation by targeting melanocytes.

Studies have reported success rates ranging from 15–100%.

Advantages: Short treatment period, low risk of scarring.

Disadvantages: Pain, high cost, sometimes local anesthesia may be required.

CONCLUSION
Laser treatments have become an important option, especially in vitiligo cases resistant to conventional treatments.

The best results are obtained with combination treatments; thus patient satisfaction and repigmentation rate increases.

Excimer laser may be the primary choice in localized and UV-sensitive areas.

LLLT is recommended for segmental vitiligo with nerve damage.

Fractional lasers may be effective in resistant areas.

Q-switched lasers are suitable for depigmentation in widespread vitiligo.