Objectives: To evaluate the synergistic effects of combining 308 nm excimer laser, fractional microneedling radiofrequency, and topical latanoprost on idiopathic poliosis. We aim to clarify session protocols, energy settings, and application techniques, while quantifying real-world repigmentation outcomes in adult patients. Emphasis is placed on understanding how these three modalities jointly reactivate dormant follicular melanocytes, and the extent to which patient age or disease chronicity influences therapeutic success.
Introduction: Idiopathic poliosis, a localized whitening of hair due to arrested melanogenesis, remains notoriously resistant to monotherapy. Previous reports suggest partial efficacy of targeted phototherapy, microneedling-induced wound healing, and prostaglandin-mediated pigment stimulation. However, evidence supporting integrated protocols is sparse. We hypothesized that combining excimer laser for localized UVB exposure, fractional RF microneedling for dermal stimulation, and latanoprost to enhance melanocyte activity may yield superior, pragmatic results.
Materials / method: Twenty-four adults (mean age 31 years) with stable idiopathic poliosis received 12 weeks of combination therapy. Excimer laser (308 nm) was applied twice weekly (initial fluence ~100 mJ/cm², escalated by 50 mJ steps). Fractional RF microneedling sessions were performed monthly at 1.5 mm depth, moderate energy (~20–30 J/cm²). Topical latanoprost 0.005% was applied nightly. Standardized digital trichoscopy, melanin index (mexametry), and a blinded Investigator Global Assessment were used at baseline, Weeks 4, 8, and 12.
Results: Repigmentation became evident by Week 8, with mean melanin index rising from 19.2 to 30.6 (p<0.001). Investigator scores indicated ≥50% repigmentation in 42% of subjects at Week 12; near-complete outcomes (≥75%) were observed in 8%. Younger patients trended toward faster and more robust color recovery. Combination therapy was well tolerated; mild erythema (laser/needling) and rare eyelid irritation (latanoprost) were self-limiting. No significant adverse events or discontinuations occurred.
Conclusion: In this pilot, multidimensional therapy combining excimer laser photobiology, fractional RF microneedling’s regenerative microtrauma, and topical latanoprost’s prostaglandin-induced melanogenesis produced meaningful, although variable, poliosis repigmentation. The consistent yet moderate improvements underscore the difficulty in achieving complete hair recoloring in short intervals. Nonetheless, these findings support a structured, synergistic approach for idiopathic poliosis and encourage larger trials to confirm long-term efficacy and refine patient selection criteria.
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