Resumen

Objectives: The aim of this study was to compare the efficacy of combination treatment by ablative carbon dioxide laser and narrowband ultraviolet B with the efficacy of combination treatment by fractional carbon dioxide laser and narrowband ultraviolet B in refractory nonsegmental vitiligo. Introduction: Vitiligo is an acquired pigmentary disorder of unknown etiology that is clinically characterized by the development of white macules related to the selective loss of melanocytes. It affects people of all ages groups and skin types. Manifestations begin before 20 years of age in 50% of the cases.. Non segmental vitiligo mainly caused by autoimmune loss of melanocytes. Genetic and environmental factors are involved in the development. Narrowband UVB is the most common form of phototherapy used to treat skin diseases. Co2 laser is one of the most widely used lasers in the dermatology field. Materials / method: This study included 30 patients of different gender and with mean age 27.7± 12.9 complaining of non segmental vitiligo. Treatment course was three sessions in two non segmental vitiligo lesions as follows; one site was treated by ablative Co2 laser in pulsed manner with power 6 and the other site treated with fractional Co2 laser with power 15, dual time 1500 and spacing 500 with one month interval. Patients used topical antibiotic cream after laser sessions then phototherapy three times per week after 5 days from laser session. Photography and clinical assessment by two blind dermatologists Results: Combination of fractional Co2 laser with narrow band is better than combination of ablative Co2 laser with narrow band in non segmental vitiligo according to improvement grade and patient satisfactions. Better response either by ablative or fractional co2 with NB-UVB was in patients of age less than 25 years old and with disease duration less than 5 years. Also, Better response either by ablative or fractional co2 with NB-UVB was in patients with negative family history. Conclusion: Combination of ablative CO2 laser with narrow band and combination of fractional CO2 laser with narrow band could be an alternative method of treatment for stable localized vitiligo in patients resistant to other methods of therapy but still with limited response, as some patients had minimal improvement and also there was no improvement in others.