title: The efficacy of 308-nm excimer laser/light (EL) and topical agent combination therapy versus EL monotherapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials (RCTs).
abstract: BACKGROUND
  Combination therapies of excimer laser/light (EL) and various topical agents are widely used in the treatment of vitiligo.
  
  
  OBJECTIVE
  We sought to compare the efficacy of EL and topical agent combination therapy versus EL monotherapy for vitiligo.
  
  
  METHODS
  Manual searches of reference lists and computerized searches of the MEDLINE, EMBASE, and Cochrane library (from inception through December 15, 2014) were conducted to identify randomized controlled trials that assessed the efficacy of EL alone or in combination with topical agents for vitiligo. The primary outcome was treatment success (≥75% repigmentation), and the secondary outcome was treatment failure (<25% repigmentation); meta-analyses were performed when possible.
  
  
  RESULTS
  We analyzed 8 randomized controlled trials comprising a total of 425 patches/patients. The combination of EL and topical calcineurin inhibitors (4 studies: relative risk 1.93, 95% confidence interval 1.28-2.91; number needed to treat 4.5, 95% confidence interval 2.9-10) was superior to EL monotherapy for vitiligo. There was insufficient evidence to support beneficial effects of topical vitamin-D3 analogs (3 studies) and corticosteroids (1 study).
  
  
  CONCLUSIONS
  These findings are based on small numbers of randomized controlled trials and heterogeneities among included studies are another limitation.
  
  
  CONCLUSIONS
  Topical calcineurin inhibitors in conjunction with EL are more effective compared with EL monotherapy.
authors.affiliation: Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea. Electronic address: jminbae@gmail.com.
authors.forename: Jung Min
authors.initials: JM
authors.lastname: Bae
authors.affiliation: Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Bo Young
authors.initials: BY
authors.lastname: Hong
authors.affiliation: Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Joo Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Ji Hae
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea. Electronic address: dermabae@gmail.com.
authors.forename: Gyong Moon
authors.initials: GM
authors.lastname: Kim
mesh_terms: D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D010789:Phototherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014820:Vitiligo / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors
keywords: excimer laser; laser; pimecrolimus; tacrolimus; topical calcineurin inhibitor; vitiligo