Efficacy of intralesional methotrexate injection versus excimer light either alone or combined in the treatment of vitiligo

Background Vitiligo management involves a variety of therapeutic approaches targeting different aspects of the disease. Treatment options include immunosuppressive and immunomodulatory agents, which help control the autoimmune process responsible for melanocyte destruction, as well as phototherapy techniques that stimulate repigmentation. Objective To compare the efficacy of intralesional methotrexate (IL-MTX) and 308 nm excimer light, administered alone or in combination, for the treatment of vitiligo. Patients and methods A single-blinded, randomized clinical study was conducted on 50 patients with localized, nonsegmental, stable vitiligo. Three comparable lesions were randomly assigned in each patient to one of three treatment modalities over 12 weeks: (1) IL-MTX once weekly, (2) Excimer light twice weekly, or (3) Combined IL-MTX and excimer light. Repigmentation was assessed using a 5-grade scale, and patient satisfaction was evaluated using a 10-point visual analog scale. Results Combination therapy resulted in the earliest onset and highest percentage of repigmentation ( P <0.001). Patient satisfaction was highest in the combination treatment ( P =0.003). Adverse reactions varied, with pain and burning sensations being more frequently observed in lesions treated with methotrexate injections, whether used alone or alongside excimer light therapy. Conclusion Combined IL-MTX and excimer light therapy demonstrated superior efficacy and patient satisfaction compared with either treatment alone, supporting its use in the treatment of localized vitiligo.