他卡西醇联合单频准分子光治疗白癜风的对照研究

目的 评价和对比他卡西醇联合单频准分子光(MEL)308nm和单用单频准分子光治疗白癜风的疗效和安全性。方法 用单盲、自身对照的方法对38例白癜风患者的自身对称或相邻的皮损分别外用他卡西醇和安慰剂,两侧皮损每周照射1次MEL 308 nm,1月观察1次,拍照对比疗效。计算最初色素再生和显效时的照光次数和光的累积量。结果 对35例患者进行评价,联合治疗侧最初色素再生时的照光次数和光的累积量分别为(4.89±3.16)次和(4.27±3.59)J/cm²,单照光侧分别为(5.69±3.29)次和(5.36±4.12)J/cm²(P<0.05),显效的患者联合治疗侧为(7.79±4.70)次和(7.72±5.64)J/cm²,单照光侧为(8.4±3.92)次和(8.18±4.87)J/cm²(P>0.05)。联合治疗侧的显效率为45.7%,总有效率71.4%,单照光侧分别为25.7%和54.3%(P<0.05)。结论 单频准分子光治疗白癜风有效而且安全,联合他卡西醇外用可增强MEL 308 nm的疗效,提早色素再生的时间和减少照光的能量。     

中波高能紫外线与308 nm准分子激光治疗白癜风的短期疗效比较

【摘要】 目的 比较中波高能紫外线和308 nm准分子激光治疗白癜风的短期疗效。 方法 中波高能紫外线组患者40例,每周照射2次;308 nm准分子激光组40例,每周1次。评估两组治疗8周后的皮损复色情况。 结果 经过8周的阶段治疗,中波高能紫外线组有83.6%皮损可出现不同程度的复色反应,达显效以上复色为42.1%;308 nm准分子激光组86.1%有皮损不同程度色素生成,达到显效以上为50%。对于面部白癜风皮损中波高能紫外线的疗效低于308 nm准分子激光（χ2 = 4.32,P < 0. 05）,在其余部位两组有效率差异无统计学意义。在皮损起始复色的累积剂量方面,两者差异无统计学意义（t = 0.89,P > 0.05）,在达到显效以上复色方面,高能中波紫外线的治疗次数和累积剂量明显多于308 nm准分子激光（P < 0. 01）。两者均适用于儿童患者及活动期皮损。 结论 中波高能紫外线或308 nm准分子激光治疗白癜风均可在短期内起效且安全,308 nm准分子激光疗效更明显。     

Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo – a multicentre controlled study

BACKGROUND: Vitiligo is an acquired pigmentary disorder characterized by areas of depigmented skin resulting from loss of epidermal melanocytes. Recently, it has been shown that narrowband ultraviolet B (NB-UVB) phototherapy may be more effective than psoralen and ultraviolet A (PUVA) photochemotherapy in treating vitiligo, and that 308-nm monochromatic excimer light (MEL) may present some advantages as compared to NB-UVB for the treatment of vitiligo. AIM The aim of this study was to compare the effectiveness of NB-UVB phototherapy and 308-nm MEL in vitiligo patients. METHODS: The study was done in a randomized, investigator-blinded and half-side comparison design. Twenty-one subjects with symmetrical vitiligo lesions were enrolled in this study. Vitiligo lesions on one body side were treated twice weekly for 6 months with 308-nm MEL, while NB-UVB phototherapy was used to treat lesions on the opposite side. RESULTS: At the end of the study six lesions (37.5%) treated with 308-nm MEL and only one lesion (6%) treated with NB-UVB achieved an excellent repigmentation (score 4) while four lesions (25%) treated with 308-nm MEL and five lesions (31%) treated with NB-UVB showed a good repigmentation (score 3). CONCLUSIONS: It appears that 308-nm MEL is more effective than NB-UVB in treating vitiligo lesions and it induces repigmentation more rapidly.     

308nm准分子激光治疗白癜风随机对照试验的系统评价

目的评价308nm准分子激光治疗白癜风的疗效和安全性。方法用计算机检索Medline(1966-2010),Embase(1984-2010)、中国生物医学文献数据库(CBM 1978-2010)。手工检索相关会议文献,文种限于中文和英文。根据纳入和排除标准筛选文献,收集所有相关随机对照试验(RCT),提取资料进行质量评价,采用RevMan5.1软件对数据进行Meta分析。结果共纳入10个RCT,包括411例患者。308nm准分子激光联合0.03%～0.1%他克莫司软膏、胸腺肽注射液治疗的无效率均小于单纯308nm准分子激光治疗[RR他合并=0.20,95%CI(0.08,0.51)],[RR胸合并=0.62,95%CI(0.41,0.93)];308nm准分子激光联合0.1%他克莫司软膏、他卡西醇软膏治疗的75%以上色素恢复率均优于单纯308nm准分子激光照射[RR=3.48,95%CI(1.39,8.70)],[OR=5.71,95%CI(1.13,28.75)];308nm准分子激光联合表皮移植治疗的75%以上色素恢复率优于单独表皮移植治疗[RR=0.14,95%CI(0.01,2.63)];308nm准分子激光治疗的75%以上色素恢复率优于NB-UVB照射[RR=6.00,95%CI(0.81,44.35)]。所有研究均未发现严重不良反应。结论 308nm准分子激光联合0.03%～0.1%他克莫司软膏、胸腺肽注射液能降低白斑消退的无效率,308nm准分子激光联合0.1%他克莫司软膏、卡泊三醇软膏能提高75%以上色素恢复率。     

单频准分子光治疗白癜风的临床研究

目的 研究观察单频准分子光308nm局部照射治疗白癜风的临床疗效,评估其安全性.方法 对77例不同临床类型的白癜风患者的201处皮损进行局部照射,每周1次,随访3-6个月.结果 经过准分子光局部照射平均18次,86.6%皮损有不同程度色素恢复,色素恢复随疗程延长而增加,照射24次总有效率为71.0%,显效率为51.6%.躯干、颈部和头面部疗效优于四肢及手足;泛发型和节段型白癜风疗效尤佳.主要不良反应为局部水疱和疼痛,患者能耐受.结论 准分子光局部照射治疗白癜风疗效显著,且不良反应少.     

Monochromatic excimer light 308 nm in the treatment of vitiligo: a pilot study

OBJECTIVE: To study the efficacy and safety of monochromatic excimer light (MEL) on 37 vitiligo patients referred to our clinic. METHODS: In a pilot study, 37 patients (17 males, 20 females) with acrofacial (n=21), focal (n=11), segmental (n=1), and generalized (n=4) vitiligo were treated twice weekly with MEL for a maximum period of 6 months. RESULTS: Thirty-five patients (95%) showed signs of repigmentation within the first eight treatments. The treatment resulted in good repigmentation in 16 patients, and excellent repigmentation in 18 patients. Adverse events were limited to transient erythema. In addition, some patients (n=3) not responding to prior narrow-band UVB (NB UVB) phototherapy showed good results with MEL in our series. CONCLUSIONS: Treatment with 308 nm MEL for vitiligo may be more effective in obtaining rapid repigmentation than phototherapy with NB UVB. The results in this study are similar to those recently reported with a 308 nm excimer laser, but 308 MEL could present some advantages: the possibility of treating larger areas compared to the 308 nm excimer laser, with shorter treatment times and better patient compliance. The overall good results and the early appearance of repigmentation contribute to reducing the cumulative exposure to UV radiation.     

308nm准分子激光治疗稳定期白癜风的疗效观察

目的 观察308 nm准分子激光治疗稳定期白癜风的疗效和安全性.方法 对30例稳定期白癜风患者采用国产308 nm准分子激光治疗,每周照射2次,每月观察1次,连续观察3个月.结果 治疗后30例患者面颈、躯干、四肢皮损复色的总有效率分别为95.0%、75.0%、66.7%,平均治疗次数分别为(10.22±1.60)次、(19.10±2.38)次、(37.74±3.06)次,三者两两比较差异均具有统计学意义(P值均＜0.05).平均累积照射剂量面颈部、躯干部和四肢依次为(7.50±3.45)、(10.60±1.01)、(18.56±3.05)J/cm2.所有患者在治疗过程中均未出现严重不良反应.结论 国产308 nm准分子激光治疗白癜风有效而且安全.

Abstract：

Objective To evaluate the efficacy and safety of 308-nm excimer light in the treatment of stable vitiligo. Methods Thirty patients with stable vitiligo were enrolled in this clinical trial. All the subjects received the treatment with 308-nm excimer light on a twice-weekly schedule for 3 months. Results The repigmentation rate was 95.0%, 75.0% and 66.7% for lesions in the face and neck, trunk and limbs, with the treatment sessions averaging 10.22 ± 1.60, 19.10 ± 2.38, 37.74 ± 3.06, respectively, and accumulative irradiation dose averaging 7.50 ± 3.45, 10.60 ± 1.01, 18.56 ± 3.05 J/cm2 respectively. Significant differences were observed in the repigmentation rate and treatment sessions between the lesions in the face and neck, trunk and limbs (all P ＜ 0.05). No severe side effects were seen during the treatment. Conclusion 308-nm excimer light is effective and safe for the treatment of vitiligo.     

Combination of 308-nm xenon chloride excimer laser and topical calcipotriol in vitiligo

BACKGROUND: A large variety of therapeutic agents are being used for the treatment of vitiligo, but treatment remains a challenge. Recently, monochromatic phototherapies such as 311-nm narrowband ultraviolet B therapy and 308-nm xenon chloride excimer laser have been reported to be an effective and safe therapeutic option in children and adult patients with vitiligo. Single reports stipulate that the addition of topically applied calcipotriol to phototherapy increases its effectiveness. OBJECTIVE: The purpose of the present pilot study was to determine if the addition of topical calcipotriol increases the efficacy of the 308-nm xenon chloride excimer in the treatment of vitiligo. METHODS: Ten patients with vitiligo with essentially bilateral symmetrical lesions were enrolled in this prospective right/left comparative, single-blinded trial conducted over a 15-month period. All patients received 308-nm XeCl excimer laser therapy three times weekly. Calcipotriol ointment (Daivonex) was applied to lesions on one side of the body twice daily. RESULTS: After 24 treatments (8 weeks), nine patients were evaluated. Eight patients showed evidence of repigmentation on both body sides, with no significant difference between the body side treated with calcipotriol and excimer laser and the side treated with excimer laser alone. The mean repigmentation rate was 22.4% (1-37%). CONCLUSION: The addition of calcipotriol ointment to 308-nm xenon chloride excimer laser phototherapy does not significantly enhance its efficacy. Small additive effects must be investigated in a larger trial.     

Treatment of Vitiligo with 308-nm xenon-chloride excimer laser: therapeutic efficacy of different initial doses according to treatment areas

Many preliminary data suggest that the 308-nm excimer laser can be a highly effective therapeutic alternative for treating vitiligo, inducing rapid repigmentation with minimal ultraviolet irradiation. We evaluated the clinical efficacy of the 308-nm excimer laser treatment for various body areas, using different initial UV doses. One hundred forty vitiligo patches from 69 patients were assigned to 4 groups; face and neck, trunk, extremities, and acral and joint areas. They were then treated twice a week, using different initial UV doses. The rate of repigmentation continued to increase with the number of treatments up to 20 sessions, and then showed plateaus between 20 to 30 sessions. On the other hand, the lesions in acral and joint areas showed the worst responses throughout the treatment sessions. Our findings extend previous observations that the 308-nm excimer laser is an effective treatment option for patients with vitiligo. However, further studies will be needed to determine the optimal dosing and administration method, especially for acral and joint areas.     

Monochromatic excimer light 308 nm in monotherapy and combined with topical khellin 4% in the treatment of vitiligo: a controlled study

Vitiligo is an acquired depigmentation disorder affecting 1–4% of the world's population. Conventional therapies include steroids, photosensitive topical agents, surgical treatments, and phototherapy. The aim of the study was to evaluate the efficacy of monochromatic excimer light 308 nm (MEL), both as a monotherapy and in combination with khellin 4% ointment in vitiligo. Forty-height patients (36 male and 12 female) affected with vitiligo were enrolled in this open prospective study. Patients were selected and divided into three groups: group I included 16 patients treated with MEL 308 nm once-weekly and oral vitamin E; group II included 16 patients treated with MEL 308 nm once-weekly combined with khellin 4% ointment (MEL-K) and oral vitamin E; group III (control group) included 16 patients treated only with oral vitamin E. Efficacy was assessed at the end of 12 weeks based on the percentage of repigmentation. Group I (MEL-group) showed a moderate repigmentation in 2/16 (12.5%) patients, good repigmentation in 10/16 (62.5%), and excellent repigmentation in 4/16 (25%) patients. Group II (MEL-K group) presented moderate repigmentation in 2/16 (12.5%) patients, good repigmentation in 5/16 (31.25%), and excellent repigmentation in 9/16 (56.25%). Group III (control group) showed a moderate repigmentation in 3/16 patients (18.75%), a good repigmentation in 1/16 (6.25%) patient, while 10/16 (62.5%) patients did not show signs of repigmentation. The clinical response achieved in group I and II was higher compared with group III (control group) without showing significant differences. MEL 308 nm, alone and/or combined with khellin 4% offered encouraging results and it may be considered a valid therapeutic option worthy of consideration in the treatment of vitiligo.     

Is the efficacy of psoralen plus ultraviolet A therapy for vitiligo enhanced by concurrent topical calcipotriol? A placebo‐controlled double‐blind study

BACKGROUND: Encouraging results of previous uncontrolled trials suggest that calcipotriol may potentiate the efficacy of psoralen plus ultraviolet (UV) A (PUVA) therapy in patients with vitiligo. OBJECTIVES: We performed a placebo-controlled double-blind study to investigate whether the effectiveness of PUVA treatment could be enhanced by combination with topical calcipotriol in the treatment of vitiligo. METHODS: Thirty-five patients with generalized vitiligo enrolled in the study. Symmetrical lesions of similar dimensions and with no spontaneous repigmentation on arms, legs or trunk were selected as reference lesions. In this randomized left-right comparison study, calcipotriol 0.05 mg g(-1) cream or placebo was applied to the reference lesions 1 h before PUVA treatment (oral 8-methoxypsoralen and conventional UVA units) twice weekly. Patients were examined at weekly intervals. The mean number of sessions and the cumulative UVA dosage for initial and complete repigmentation were calculated. RESULTS: Twenty-seven patients (nine women, 18 men; mean +/- SEM age 29.8 +/- 13.5 years) were evaluated. The mean +/- SEM cumulative UVA dose and number of UVA exposures for initial repigmentation were 52.52 +/- 6.10 J cm(-2) and 9.33 +/- 0.65 on the calcipotriol side, and 78.20 +/- 7.88 J cm(-2) and 12.00 +/- 0.81 on the placebo side, respectively (P < 0.001). For complete repigmentation, respective values were 232.79 +/- 14.97 J cm(-2) and 27.40 +/- 1.47 on the calcipotriol side and 259.93 +/- 13.71 J cm(-2) and 30.07 +/- 1.34 on the placebo side (P = 0.001). Treatment with calcipotriol and PUVA resulted in significantly higher percentages of repigmentation for both initial (81%) and complete pigmentation (63%), compared with placebo and PUVA (7% and 15%, respectively). CONCLUSIONS: Our results have shown that concurrent topical calcipotriol potentiates the efficacy of PUVA in the treatment of vitiligo, and that this combination achieves earlier pigmentation with a lower total UVA dosage.     

Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo

OBJECTIVE: To compare the efficacy of combined tacrolimus and 308-nm excimer laser therapy vs 308-nm excimer laser monotherapy in treating vitiligo. DESIGN: Comparative, prospective, randomized, intraindividual study. PATIENTS: Fourteen patients, aged 12 to 63 years, with Fitzpatrick skin types II to IV. INTERVENTION: For each patient, 4 to 10 target lesions were chosen. The treatment applied to each target lesion was randomized by drawing lots. Each lesion was treated twice a week by the 308-nm excimer laser, for a total of 24 sessions. Initial fluences were 12 mcal/cm(2) (50 mJ/cm(2)) less than the minimal erythemal dose in vitiliginous skin. Then, fluences were increased by 12 mcal/cm(2) every second session. Moreover, topical 0.1% tacrolimus ointment was applied twice daily on target lesions receiving the combined tacrolimus and excimer laser treatment (group A). Group B target lesions received only excimer laser monotherapy. For each treated lesion, the untreated lesion on the opposite side served as the control. Tolerance was evaluated by a visual analog scale, and secondary events were recorded at each session. MAIN OUTCOME MEASURE: Treatment efficacy, which was blindly evaluated by 2 independent physicians by direct and polarized light photographs taken before and after treatment. RESULTS: Forty-three lesions were treated (23 in group A and 20 in group B). All patients completed the study. Repigmentation was observed in all group A lesions (100%) and in 17 (85%) of the 20 group B lesions. Repigmentation was not observed in the untreated lesions (control group). A repigmentation rate of 75% or more was obtained in 16 (70%) of the 23 group A lesions and in 4 (20%) of the 20 group B lesions. In UV-sensitive areas (the face, neck, trunk, and limbs, with the exception of bony prominences and extremities), 10 (77%) of 13 group A lesions had a repigmentation rate of 75% or more vs 4 (57%) of 7 group B lesions. In classically UV-resistant areas, 6 (60%) of 10 group A lesions had a repigmentation rate of 75% or more vs 0 of the 13 group B lesions. The mean number of sessions necessary for an improvement of repigmentation was 10 in group A and 12 in group B. Adverse effects have been limited, and tolerance was excellent. CONCLUSIONS: The combination treatment of 0.1% tacrolimus ointment plus the 308-nm excimer laser is superior to 308-nm excimer laser monotherapy for the treatment of UV-resistant vitiliginous lesions (P<.002). The efficacy and the good tolerance of the 308-nm excimer laser in monotherapy for treating localized vitiligo were also confirmed, but this treatment regimen should be proposed only for UV-sensitive areas.     

The 308-nm excimer laser: a promising device for the treatment of childhood vitiligo

Background: Numerous modalities have been used to treat vitiligo in children. Up to now, phototherapy and topical corticosteroids are the most commonly used treatments for adult vitiligo but studies evaluating the efficacy of these treatments in the pediatric population remain insufficient. Objective: This study was a retrospective review to evaluate the efficacy and safety of 308‐nm excimer laser treatment in 30 childhood vitiligo patients. Methods: Thirty vitiligo patients with 40 vitiligo patches were evaluated after the cessation of 308‐nm excimer laser treatment. Results: Seventeen patients (56.7%) with 20 patches (50%) achieved an acceptable degree (>50%) of repigmentation at the end of the treatment, with five patches (12.5%) showing >75% of repigmentation. The treatment response showed anatomical preferences, favoring the face, neck and trunk. However, the treatment response did not correlate to the cumulative dose or duration of treatment. Side effects occurred in nine patients, but were transient and minimal. Conclusion: The results of this study shows that the 308‐nm excimer laser can be an effective and promising device for the treatment of various vitiligo types, other than generalized, in childhood.     

Monochromatic excimer light versus combination of topical steroid with vitamin D3 analogue in the treatment of nonsegmental vitiligo: a randomized blinded comparative study

Vitiligo is a difficult disease to treat, socially stigmatizing its patients. Monochromatic excimer light (MEL) was developed for use in dermatology and adapted for the treatment of vitiligo. Comparing the efficacy of MEL versus topical combination therapy of vitamin D3 analogue and steroid in the treatment of nonsegmental vitiligo. Forty‐four patients with localized and stable nonsegmental vitiligo participated in the present study. In each patient, two lesions were selected and divided randomly into two groups, group A was treated with daily topical combination of calcipotriol and betamethasone and group B was treated with biweekly sessions of MEL for 3 months. Efficacy based on repigmentation percentages were blindly evaluated by two independent physicians and patient's satisfaction. There was significant improvement in both treatment modalities at the end of the study, but without significant differences in both groups. There was a significant difference between both groups regarding the onset of repigmentation (p‐value < 0.05), whereas group B showed early sign of repigmentation in first 4 weeks of treatment in 16 patients versus 7 patients in group A. Both treatment modalities offered encouraging results and both are promising lines for the treatment of vitiligo.     

The effectiveness of excimer laser on vitiligo treatment in comparison with a combination therapy of Excimer laser and tacrolimus in an Iranian population

Abstract

Objectives: Usage of 308-nm excimer laser (EL) is an effective treatment in vitiligo. As genetic predispositions along with type of skin and rate of sun exposure are known factors influencing the treatment outcomes, we tried to evaluate the treatment results of using 308 nm-excimer laser alone in comparison with the combined therapy of EL and topical tacrolimus in Iranian patients with vitiligo. Methods: We reviewed the medical files of 150 patients with vitiligo who were referred to the Behsima Laser Center between April 2012 and April 2013. Seventy five patients who received combined therapy of 308 nm EL and topical tacrolimus three times a week entered the study. Seventy-five controls with matched characteristics and who received only EL were also selected. The amount of repigmentation was estimated by an expert dermatologist and was classified in 5 ranks. Results: In the case group, 33.3% (n: 25) showed 50–75% repigmentaion and 49.3% (n:37) had more than 75% response to therapy, whereas among the patients in the control group 29.3% (n: 22) showed no repigmentation and only 8% (n: 6) demonstrated more than 75% repigmentation response. The higher efficiency of the combination therapy on repigmentation was statistically significant (P: 0.006). Conclusion: Our study shows that Iranian patients with vitiligo who received a combined treatment course with 308-nm EL and tacrolimus 0.1% experienced significantly higher levels of repigmentation in comparison with laser therapy alone.     

Optimal weekly frequency of 308-nm excimer laser treatment in vitiligo patients

BACKGROUND: Recently the beneficial effect of excimer laser treatment has been reported for patients with vitiligo. The influence of treatment frequency on this effect is not clear. OBJECTIVES: To determine the optimal frequency of 308-nm excimer laser therapy for vitiligo. METHODS: In this prospective, university-based hospital study over 12 weeks we enrolled 14 patients. Each had at least three stable vitiligo lesions in the same body area. The three stable vitiligo lesions in each subject were randomly assigned to receive excimer laser treatment once (1 x), twice (2 x) and three times (3 x) weekly, respectively. The initial ultraviolet (UV) dose was 50 mJ cm(-2) less than the 308-nm minimal erythematous dose in vitiligo skin. The UV dose was increased at each treatment session according to the erythematous response to the previous treatment. RESULTS: Thirteen subjects were treated for at least 6 weeks; seven were treated for all 12 weeks. At 6 weeks, the repigmentation rates for treated lesions were 8% (1/13) after 1 x weekly treatment, 23% (3/13) after 2 x weekly treatment and 62% (8/13) after 3 x weekly treatment (P = 0.0134; 3 x vs. 1 x weekly); at 12 weeks, these rates were 46% (6/13), 62% (8/13) and 69% (9/13), respectively (P = NS; 3 x vs. 1 x weekly). Repigmentation initiation correlated with treatment number, regardless of frequency (P = NS). As shown by Kaplan-Meier analysis, repigmentation occurred earliest in the most frequently treated lesions (P = 0.0336). At 12 weeks, the projected repigmentation rates for 1 x, 2 x and 3 x weekly treatment approached each other (60%, 79% and 82%, respectively); the mean repigmentation grades (on a scale of 0-5) for 1 x, 2 x and 3 x weekly treatment were 1.7, 2.4 and 3.3, respectively (P = 0.018; 3 x vs. 1 x weekly). Laser-induced repigmentation persisted in most cases over the entire follow-up of 12 months after the end of treatment. CONCLUSIONS: 308-nm excimer laser therapy is effective against vitiligo. Although repigmentation occurs fastest with 3 x weekly treatment, the ultimate repigmentation initiation seems to depend entirely on the total number of treatments, not their frequency. However, treatment periods of more than 12 weeks may be necessary to obtain a satisfactory clinical repigmentation, particularly when vitiligo lesions are treated only 1 x or 2 x compared with 3 x weekly.     

The efficacy of excimer laser (308 nm) for vitiligo at different body sites

BACKGROUND: The treatment with XeCl-excimer laser generated 308-nm UVB radiation has shown promising results in patients with vitiligo. OBJECTIVE: In this controlled, prospective trial we studied the primary efficacy (start and grade of repigmentation) and patient's satisfaction of XeCl-excimer laser for treatment of vitiligo patches at different body sites and re-evaluated the achieved repigmentation 12 months after the end of therapy. METHODS: Twenty-five patients with generalized or localized vitiligo with a total of 85 lesions at different body sites were enrolled in this study. Vitiligo patches were treated with 308-nm XeCl-excimer laser 3 times a week for 6 to 10 weeks. The overall repigmentation grade of each treated lesion was evaluated once a week on a 5 point scale rating from 0 (no repigmentation), 1 (1-5%), 2 (6-25%), 3 (26-50%), 4 (51-75%), to 5 (76-100%). RESULTS: Twenty-four patients completed the study. Within 6 to 10 weeks of treatment 67% of the patients (16/24) developed follicular repigmentation of at least one of their vitiligo lesions. Lesion repigmentation started after a mean of 13 treatments in lesions located on the face, trunk, arm, and/or leg (high-responder location), and after a mean of 22 treatments in lesions located on the elbow, wrist, dorsum of the hand, knee, and/or dorsum of the foot (low-responder location). Untreated control lesions and lesions located on the fingers did not achieve any repigmentation. After 10 weeks of treatment repigmentation of more than 75% was found in 25% (7/28) of lesions of the high-responder location group versus 2% (1/43) of lesions of the low-responder location group. In most cases, laser-induced repigmentation was persistent, as determined 12 months after the end of treatment. CONCLUSIONS: 308-nm excimer laser is an effective modality for the treatment of vitiligo. However, similar to other non-surgical treatment modalities, the therapeutic effect is mainly dependent on the location of vitiligo lesions.     

308 nm准分子激光联合他克莫司乳膏治疗儿童面颈部白癜风疗效观察

目的 评价308 nm准分子激光联合0.03%他克莫司乳膏治疗儿童面颈部白癜风的疗效及安全性。 方法 68例儿童面颈部白癜风（年龄 ≤ 14岁）,根据皮损部位分为皮损组（包括面颈部）;腔口组（包括口周、眼周）;均给予308 nm准分子激光照射,每周1 ～ 2次,20次1个疗程;联合外用0.03%他克莫司乳膏,每日2次,疗程结束后分别进行疗效评价,并观察红斑反应及照射累积量对疗效的影响。结果 20次治疗结束后,皮损组显效率78.4%,腔口组显效率54.8%,皮损组显效率优于腔口组（P < 0.05）。两组在治疗过程中红斑反应持续48 h以上的平均次数分别是皮损组5.84次、腔口组9.12次。腔口组红斑反应持续48 h以上的平均次数明显多于皮损组（P < 0.01）。两组在完成10次和20次治疗后的平均照射累积量分别是：皮损组4215 mJ/cm2（10次）、10 453 mJ/cm2（20次）;腔口组3364 mJ/cm2（10次）、7430 mJ/cm2（20次）,皮损组平均照射累积量均大于腔口组（P < 0.01）。结论 308 nm准分子激光联合0.03%他克莫司乳膏治疗儿童面颈部白癜风是安全、有效的,面颈部疗效好于面部腔口部位,且后者红斑反应重于前者。     

他卡西醇软膏治疗白癜风的自身对照观察

目的：观察他卡西醇外用治疗白癜风的疗效与安全性。方法：采用单盲、自身对照的方法,对34例白癜风患者的自身对称或相邻皮损分别外用他卡西醇或安慰剂．1个月观察1次疗效。结果：对30例患者进行评价,他卡西醇外用耐受性好,治疗侧皮损有效率为73.3％,对照侧为36.7％,治疗侧最初色素再生时间早于对照侧,临床特征与疗效无相关性。结论：他卡西醇治疗白癜风有效,而且安全。     

A review of monochromatic excimer light in vitiligo

Phototherapy is a mainstay of vitiligo treatment and has varying rates of efficacy. Narrowband ultraviolet (UV) B (NB‐UVB) and UVA have been used for decades, but it is only recently that monochromatic excimer light (MEL) was developed for use in dermatology and adapted for the treatment of vitiligo. The specific 308‐nm radiation wavelength is delivered in a targeted form by the xenon‐chloride excimer laser and is also available in an incoherent form that is commonly referred to as the excimer lamp. MEL administered by both laser and lamp has shown efficacy superior to NB‐UVB for the treatment of vitiligo and induces more changes at the cellular level than conventional UVB modalities. The excimer laser is effective in adults and children with vitiligo in all skin types as monotherapy or in combination with other established vitiligo therapeutics. Treatment regimens studied included excimer laser two to three times weekly for up to 36 weeks. Patients commonly achieved > 75% repigmentation. The laser has also been used in combination with topical corticosteroids, calcineurin inhibitors and vitamin D analogues, as well as surgery, thus further expanding treatment options for patients with vitiligo. The excimer lamp has been used for treatments one to three times a week for up to 24 weeks and was found to be equal to excimer laser in a head‐to‐head comparison. It has also been used in combination with topical corticosteroids and oral vitamin E. Both MEL modalities have a limited adverse side‐effect profile. Long‐term effects are yet to be determined; however, based on available data on UVB phototherapy as well as the properties of MEL devices, there is probably only a minimal increased malignancy risk.