Short and Long-Term Outcomes of 308-nm Laser for Pediatric Vitiligo

July 2022 | Volume 21 | Issue 7 | 773 | Copyright © July 2022


Published online June 30, 2022

Sumit Sethi MBBS MD DNBa, Nanette B. Silverberg MDb,c

aDepartment of Dermatology, Venkateswar Hospital, Dwarka, New Delhi, India
bDepartment of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY
cDepartment of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, NY

Abstract
Pediatric vitiligo is often challenging to treat. Children with vitiligo experience stigma, bullying, and emotional distress. The long-term outcome of therapeutics used to treat pediatric vitiligo has been poorly documented in the literature. It is, therefore, hard to counsel patients on the expected long-term results of therapy. We sought to address outcomes in pediatric vitiligo treated with a 308-nm laser. An IRB-exempt chart review was conducted in June of 2016 of children undergoing active 308-nm laser in the first half of 2016. Demographic data, location of disease, therapeutic parameters of the 308-nm laser, and outcomes were recorded at that time. In 2021, the long-term outcomes were analyzed through chart review addressing pigmentation retained at later office visits. Initial repigmentation was noted in 86.7% of the face, 80% of the body, and 61.7% of the extremities. An average of 3.38 years of follow-up was recorded. Scoring extent of vitiligo using 18 site-scoring was helpful in identifying individuals who are less likely to respond to 308-nm laser, but needs broader evaluation. During that time, repigmentation was noted to be retained in 80% of facial, 40% of the body, and 20% of extremity lesions. Pediatric vitiligo responds well to the 308-nm laser, with the best retention of repigmentation for facial lesions. Patients and parents should be counseled on the likelihood of long-term retention of repigmentation and regarding the need for the ongoing management of vitiligo even after repigmentation is initially achieved after 308-nm laser therapy.

J Drugs Dermatol. 2022;21(7):773-775. doi:10.36849/JDD.6895

INTRODUCTION

Children with lesions on the face and other visible sites are subject to bullying and may have a poor quality of life.1 308-nm laser is used to enhance vitiliginous lesion repigmentation, with limited data in children. Face, neck, and trunk sites respond superiorly.2 It has been demonstrated that repigmentation with a 308-nm laser for vitiligo in children is enhanced with the addition of topical calcineurin inhibitors.3 In larger series addressing outcomes of pediatric vitiligo with traditional therapy, 42.3% achieve a “looking excellent” score, supporting the possibility of good clinical outcomes with traditional interventions for therapy, which includes a 308-nm laser.4 Despite the utility of 308-nm laser as a modality of therapeutic repigmentation, little is known about the retention of pigmentation after treatment.

MATERIALS AND METHODS

An IRB-exempt chart review was conducted in 2016 of children with vitiligo who received a 308-nm laser. Patients were identified through a review of logbooks for individuals actively receiving 308-nm laser from 1/1/2016-6/30/2016. Analysis of available charts was conducted with the extraction of the age of the patient, location and type of lesions, Fitzpatrick skin type, number of sessions and average dosage of 308-nm laser, concomitant therapy, response to the 308-nm laser by the site (face, body, extremities).

All patients received concurrent tacrolimus ointment with the concentration of tacrolimus at 0.1% for 16 years and over, and 0.03% for 2-15 years of age for the duration of laser treatment. Twice-daily application of tacrolimus was requested. For body lesions, mometasone ointment once daily or daily pulsed clobetasol ointment 2 weeks per month (maximum 3 months) were given adjunctively in addition to tacrolimus.

Patients included in the chart review had their chart re-examined in 2021 for the long-term course and retention of pigmentation.

RESULTS

17 names were identified; however, only 15 charts were available for review at the time of the chart review (Table 1). Patients were on average 10.24 years of age with a mean vitiligo duration of 20.9 months. Seven cases were non-segmental (46.7%), 7 segmental (46.7%) and 1 mixed segmental/ non-segmental (6.6%). All but 1 patient was Fitzpatrick skin types 3-6. The body site most commonly treated was the face 86.7%, followed by legs 33.3%.

Patients with facial disease, whether in isolation or as part of generalized involvement had the best outcomes. Average repigmentation by surface area was 86.7% for the face, 80% for the body, and 61.7% for the extremities.
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