Poster Presentation Australasian Society for Dermatology Research Annual Scientific Meeting 2024

Excimer Laser in the Treatment of Vitiligo: A Systematic Review and Network Meta-Analysis  (#59)

Wey Han WN Ng 1 , Zhengyang ZL Liu 2 , Zhao Feng ZL Liu 3 , Samuel SM Morriss 4 , Lawrence LL Lin 5 , Firdavis FX Xireaili 6 , Christopher CC Chew 7
  1. Faculty of Medicine, Nursing and Health Sciences , Monash University, Melbourne, Victoria, Australia
  2. Royal Melbourne Hospital, Melbourne, Victoria, Australia
  3. Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
  4. Royal Melbourne Hospital, Melbourne, Victoria, Australia
  5. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  6. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  7. Department of Dermatology, Victorian Melanoma Service, Alfred Health, Monash Health, Melbourne, Victoria, Australia

Introduction

Phototherapy remains integral for treating vitiligo, via cutaneous immunosuppression which stimulates the differentiation of melanocyte stem cells and melanin production1. Excimer laser (308nm) is an increasingly available form of phototherapy. However, combination therapies to improve the repigmentation rate have not been well evaluated. The purpose of this systematic review and meta-analysis (SRMA) is to evaluate which adjuvant therapy, in combination with excimer laser is most efficacious in treating vitiligo.

Description

A systematic search was conducted on MEDLINE, Embase and Cochrane Library from inception to the 9th of July 2022, using a comprehensive set of search terms to identify studies investigating excimer laser and adjuvant therapies to treat vitiligo. Data from the relevant studies was extracted into standardised spreadsheets.

The primary outcome was treatment efficacy, in terms of the proportion of patients achieving >50%, >75% and >100% repigmentation. Secondary outcomes such as patient satisfaction and erythema were assessed, where available. Data analysis was performed using the “netmeta” package in R to produce network graphs to visualise the structure of the network comparisons and direct evidence plots. Network model inconsistency was analysed using the net splitting approach for comparisons and net heat plots for contributory study designs. 

Major Findings

Our search identified 593 studies. After screening, 45 studies (from 2005 to 2022) involving 5646 participants were included. The studies were primarily single-centre randomised controlled studies (77.8%). 38 studies assessed >50% repigmentation, which found excimer laser combined with topical calcineurin inhibitors (OR 2.86) and platelet-rich plasma (PRP) injections (OR 4.94) were significantly more effective than monotherapy. Similarly, to achieve 75% repigmentation, excimer laser with calcineurin inhibitor was found to be superior (OR 4.48). No significant inconsistencies across study designs were identified. 

Conclusion

Excimer laser is an effective therapy for vitiligo, particularly when combined with concurrent topical therapy such as calcineurin inhibitors. 

  1. 1. Post NF, Ezekwe N, Narayan VS, Bekkenk MW, Van Geel N, Hamzavi I, et al. The use of lasers in Vitiligo, an overview. Journal of the European Academy of Dermatology and Venereology. 2022 Mar 1;36(6):779–89. doi:10.1111/jdv.18005