A Comparative Study of Efficacy of Ablative Fractional CO2 Laser Plus 5% 5-Fluorouracil Cream Versus Monotherapy with Ablative Fractional CO2 Laser or 5% 5-Fluorouracil Cream in Treatment of Stable Vitiligo

Export Objective: Vitiligo is an acquired pigmentary disorder, characterized by depigmented macules, which are caused by the disappearance of functional melanocytes. Although disease does not have any systemic complications, it is of great cosmetic concern. Many patients with vitiligo remain in the refractory state despite the availability of numerous potential treatments. Ablative fractional CO2 (AFCO2) laser has been introduced into the treatment of vitiligo. The aim of this work was to evaluate the effectiveness and side effects of combination therapy with AFCO2 laser followed by 5% 5-fluorouracil (5-FU) cream compared to the monotherapy with AFCO2 laser or 5% 5-FU cream in the treatment of stable vitiligo. Methods: The study was an interventional prospective therapeutic comparative study. It included (52 patients with 182 vitiliginous patches) of stable vitiligo. Patients were randomly divided into three groups as follows: group A (8 patients with 31 patches) treated with 5% 5-FU cream, group B (22 patients with 78 patches) treated with AFCO2 laser, and group C (22 patients with 73 patches) treated with AFCO2 laser followed by application of 5% 5-FU cream. For the three groups, six sessions were done with monthly intervals then the patients were seen 2 months after the last session. All vitiligo patches were assessed by the researcher and independent dermatologist at baseline visits, monthly, and after the end of the study. Patient’s satisfaction was recorded and side effects were noticed. Results: There was a significant statistical difference noticed among the three groups. The percentage of patients who achieved G3 (good) and G4 (excellent) scores was 54.6% in the group C, 12.5% in the group A, and 9.1% in the group B. In addition, the response was significantly faster in the group C with 66.7% occurred after the first session while in the group A (62.5%) after the fourth session and in the group B (66.6%) after the third session. The patient’s satisfaction was significantly different with the best results for the combined treatment group; 54.5% was very satisfied. Furthermore, the adverse effects of all groups (pain, erythema, and itching) were tolerable during sessions or at the site of 5-FU cream application. Post-inflammatory hyperpigmentation was temporary and acceptable by all patients. Conclusions: AFCO2 laser is an effective and safe method for the treatment of vitiligo when used alone or better when followed by 5-FU probably acting to facilitate drug delivery.