title: Effect of a preceding laser dermabrasion on the outcome of combined therapy with narrowband ultraviolet B and potent topical steroids for treating nonsegmental vitiligo in resistant localizations.
abstract: BACKGROUND
  The treatment of vitiligo remains unsatisfactory.
  
  
  OBJECTIVE
  To assess in patients with vitiligo the effect of a laser dermabrasion in addition to the association of topical steroids and ultraviolet (UV) B in difficult-to-treat areas.
  
  
  METHODS
  This was a single-centre prospective randomized trial including patients with nonsegmental vitiligo who had at least two symmetrical lesions located on bony prominences and/or extremities. An erbium laser-assisted dermabrasion was first performed on one side (randomly assigned). After 48 h, hydrocortisone 17-butyrate cream applied daily for three periods of 3weeks followed by a 1-week steroid-free interval and narrowband UVB treatment was performed on both sides twice weekly for 12weeks. The evaluation was performed on standardized pictures by two physicians blinded to the type of treatment received. The criterion of success was a repigmentation of at least 50%, 1month after the end of the treatment.
  
  
  RESULTS
  Eighteen patients were included (24 paired lesions treated). Two patients dropped out for personal reasons. Almost 50% of lesions achieved at least 50% repigmentation in the dermabrasion side while only 4·2% did so with topical steroids and UVB alone (P<10(-4) ). Side-effects were delayed healing, pain and two hypertrophic scars. The tolerance and patient satisfaction were 4·2 and 4/10 for the laser-treated side and 8·4 and 3/10 in the UVB+ steroids alone group, respectively.
  
  
  CONCLUSIONS
  Laser dermabrasion significantly improves the repigmentation rate in vitiligo lesions. Despite a high rate of repigmentation in such difficult-to-treat areas the high rate of side-effects and the poor tolerance strongly limit its use in current practice.
authors.affiliation: Departments of Dermatology Clinical Research, University Hospital of Nice, 06200 Nice, France.
authors.forename: W
authors.initials: W
authors.lastname: Bayoumi
authors.forename: E
authors.initials: E
authors.lastname: Fontas
authors.forename: L
authors.initials: L
authors.lastname: Sillard
authors.forename: F
authors.initials: F
authors.lastname: Le Duff
authors.forename: J-P
authors.initials: JP
authors.lastname: Ortonne
authors.forename: P
authors.initials: P
authors.lastname: Bahadoran
authors.forename: J-P
authors.initials: JP
authors.lastname: Lacour
authors.forename: T
authors.initials: T
authors.lastname: Passeron
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003869:Dermabrasion / Q000379:methods*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014467:Ultraviolet Therapy / Q000379:methods*; D014820:Vitiligo / Q000628:therapy*
chemical_list: D003879:Dermatologic Agents; C033014:hydrocortisone 17-butyrate 21-propionate; D006854:Hydrocortisone