Role of insulin in combination with fractional carbon dioxide laser in treatment of nonsegmental vitiligo: a controlled study

Background Treatment of vitiligo targets controlling immunological pathways, stimulating melanocyte regeneration, and decreasing oxidative stress. Insulin can increase the synthesis of multiple growth factors when applied topically. It regulates re-epithelization, inflammatory responses, increases angiogenesis, regulation of inflammatory reactions, and decreases reactive oxygen species. Fractional carbon dioxide laser (fractional CO 2 ) can increase the absorption of topically applied medications, as it forms microscopic, coagulated columns within the intact skin. Objective To assess the efficacy and safety of insulin applied topically with assisted delivery using fractional CO 2 laser in the treatment of vitiligo. Patients and methods In this controlled study, 60 vitiligo patients were included; they were divided into two groups., both underwent a weekly session of fractional CO 2 laser for 12 weeks. Group 1 applied insulin topically postsession once/day until the next session. The evaluation was done using Vitiligo Extent Score for Target Area before the treatment and at 6 then 12 weeks. Results Vitiligo extent score for a target area score showed improvement after 6 weeks in group 1 with no improvement in group 2 with P value less than 0.0001 and after 12 weeks there was marked improvement in group 1 with median range 62 (0–100) while in group 2 it was 10 (0–70) with a statistically significant P value less than 0.001. Conclusion Topically applied insulin combined with fractional CO 2 laser may have a safe and effective role in the treatment of vitiligo.