Abstract

Objectives: Recently, the monochromatic excimer light (MEL) has been used to treat vitiligo. The radiation wavelength of 308-nm can be delivered by the xenon-chloride excimer laser in a targeted form, or by an excimer lamp in an incoherent form. Introduction: Vitiligo is the most common cause of depigmentation, with a prevalence of around 0.1% to 2%. In a 2020 randomized placebo-controlled trial, ruxolitnib cream resulted in substantial repigmentation of vitiligo lesions and was well tolerated amongst subjects.6 Both topical ruxolitnib and MEL have shown efficacy for the treatment of vitiligo, while being well tolerated amongst patients. Thus, we report a case of segmental vitiligo treated with ruxolitnib and the 308nm MEL delivered with an excimer lamp. Materials / method: A 43-year-old Black male presented to our office with a 3-month history of white patches on the right maxilla region of the face. The patient was started on ruxolitnib 1.5% topical cream twice daily to the affected areas. At 4 month follow-up, mild improvement was observed (Figure 2). The patient received 308nm MEL with an excimer lamp, with an energy of 100mj/cm2 for 2 seconds for each lesion. Ruxolitnib cream twice daily was continued, and he received the 308-nm excimer light twice weekly with increasing energies as tolerated. Results: As noted in the materials and methods, the depigmented macules and patches on the right nasal labial fold and lower cheek before treatment with ruxolitinib cream twice daily were unchanged. The patient achieved mild improvement after four months of the introduction of ruxolitinib. Significant repigmentation was not observed until the 308nm excimer lamp was added for 10 months. Complete repigmentation of the lower cheek, greater than 50% improvement of the right nasal labial fold, and 50% improvement of the right ala of nose. Conclusion: Ruxolitnib in combination with the MEL delivered with a 308nm excimer lamp resulted in significant repigmentation in the lesions of segmental vitiligo. Given the difficulty in treating segmental vitiligo, in combination with the safety and tolerability of these modalities, this treatment could be an effective therapy for such patients. Clinical trials to determine long term safety data are needed.