Platelet‐rich plasma injection versus combined fractional carbon dioxide laser with platelet‐rich plasma in treatment of vitiligo: A comparative study

To the editor, Fractional CO2 (Fr: CO2) laser is proposed to be effective in the treatment of refractory nonsegmental vitiligo by the following mechanisms. First, it produces immediate tissue contraction (shrinkage), which narrows the size of the vitiligo lesions. Second, there is secretion of cytokines and various growth factors during wound healing, which may serve as mitogens for melanocytes from adjacent normal skin and hair follicles. Third, fractional laser promotes transepidermal penetration of UV and topical agents, enhancing their effect.1 Platelet-rich plasma (PRP) is composed of high concentration of platelets with high concentration of growth factors (GFs). This may help in stimulation of the proliferation of melanocytes and repigmentation within vitiliginous patches.2 Dermoscope can be useful in monitoring disease activity and the stage of evolution. On dermoscopy, vitiligo typically shows residual perifollicular pigmentation and telangiectasia, which are absent in other hypopigmentation disorders.3 We conducted a comparative, controlled study on 20 adult patients with localized nonsegmental stable vitiligo and Fitzpatrick skin type II-III-IV IV. Patients were randomly divided into two groups by computer-generated random number inserted in opaque sealed envelope and were enrolled in this study. For each patient, one side of the body was treated with PRP, while the other side was treated with Fractional CO2 laser and PRP. Patients received six treatment sessions with 2-week interval for 2.5 months and will be followed up 3 months after last session. Written and informed consent obtained from all patients before study enrollment. Dermoscope was used to assess disease activity as well as response to treatment. Ten milliliters of venous blood aspirated from the antecubital vein under complete aseptic conditions. The whole blood sample collected in tubes containing sodium citrate as an anticoagulant (sodium citrate 9NC, VACO MED, containing sodium citrate 3.2% as anticoagulant). Then, the citrated blood centrifuged in a standard laboratory centrifuge for 7 min at 2016 g. Subsequently, the yellow plasma (containing buffy coat with platelets and leukocytes) was taken up using a micropipette. A second round of centrifugation was performed for 5 min at 3942 g.4 The study showed that laser and PRP treatment achieved better results than PRP treatment regarding patient's satisfaction and improvement. Excellent improvement showed higher frequency after Laser and PRP treatment, while lower grades of improvement (no, minimal, and moderate) showed higher frequency after PRP treatment. The group treated with combined Fr: CO2 with PRP showed higher significant size reduction when compared to PRP group. Better results were achieved as we added more sessions and using dermoscope in follow-up of patients was very helpful (Figures 1, 2). To the best of our knowledge, this study was the first one for adding dermoscope in diagnosis and follow-up of the patients in this type of treatment of stable nonsegmental vitiligo and we added more sessions to increase the chance for improvement. Combining laser with PRP showed better improvement than PRP alone. The Mansoura Faculty of Medicine's Institutional Review Board (IRB) accepted this report (MS. 19.04.580). Informed written consent taken from all patients.