Excimer Light and Erbium Laser: A Dual Solution for Vitiligo

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Influenced by genetic and environmental factors, vitiligo can have significant physical and psychological impacts.¹ Therapeutic advancements have sought to address the challenges associated with this condition, particularly the limitations of conventional treatments like narrowband ultraviolet B (NB-UVB) phototherapy.² To better understand the effects of various UV therapies on this condition, a recent study assessed the efficacy of combining 308 nm excimer light and 2940 erbium laser for the treatment of localized vitiligo.³

308 nm Excimer Light and 2940 Erbium Laser

The 308 nm excimer light emits targeted ultraviolet B radiation, stimulating melanocyte activity and promoting repigmentation. Researchers stated this therapy’s precision and safety make it suitable for localized lesions in both children and adults.⁴ However, they noted excimer light therapy often reaches a plateau, particularly in treating resistant areas such as acral regions, necessitating a need for combination strategies.⁵ 

The 2940 erbium laser operates at the peak wavelength for absorption, effectively vaporizing superficial skin layers with minimal thermal damage. The study stated this laser stimulates collagen remodeling, enhances melanocyte proliferation, and increases the absorption of topical medications.6 Its minimal adverse events and rapid recovery make it an ideal adjunctive therapy for vitiligo.

Methods

The retrospective observational study assessed the efficacy of combination therapy using the 308 nm excimer light and the 2940 erbium laser. Patients with nonsegmental vitiligo were recruited and divided into 2 groups. Group A received combination therapy, while Group B underwent excimer light monotherapy. 

The treatment protocol for Group A involved fortnightly sessions combining the excimer light and the erbium laser. Each session began with excimer light treatment set at 2000 mJ/cm² and a 40 ms pulse width, followed by the application of the erbium laser set at 1900 mJ/pixel in long-pulse mode. Group B participants received fortnightly excimer light treatments alone. Both groups applied topical 0.1% tacrolimus ointment and took oral folic acid and vitamin B1 throughout the study. Cold compresses and sun protection measures were provided post-treatment.

Lesions were monitored over 26 weeks. Responses were categorized by levels of repigmentation, ranging from poor (<25%) to excellent (≥75%). Treatment duration, the onset of repigmentation, and changes in lesion size were systematically recorded.

Results

Overall, the study included 104 patients (38 men and 66 women) with 181 lesions analyzed across the head, neck, trunk, limbs, and acral regions. Researchers found combination therapy demonstrated“significantly” higher rates of repigmentation compared to monotherapy. Most lesions treated with the combination therapy showed visible improvement within 10 weeks, whereas the monotherapy group achieved comparable outcomes around the 12-week mark.

The study stated lesions on the head and neck regions responded most favorably to the combination therapy, reflecting their sensitivity to phototherapy. Trunk and limb lesions also demonstrated substantial improvement, further underscoring the effectiveness of the combined approach. It found acral regions, however, exhibited limited response, indicating the need for alternative or supplemental strategies in these areas.

Challenges and Future Directions

Despite its advantages, the study noted combination therapy has limitations, including higher costs and specialized equipment needs. Acral lesions remain resistant, indicating to researchers a need for alternative strategies, such as surgical interventions or emerging therapies. Economic considerations suggested starting with monotherapy and introducing combination therapy later to overcome plateaus in treatment efficacy.

Conclusion

The study found the integration of 308 nm excimer light and 2940 erbium laser represents a significant advancement in vitiligo treatment, offering improved outcomes and shorter treatment durations. Researchers suggested future research should focus on refining protocols, addressing cost barriers, and exploring innovative approaches for refractory cases to maximize the potential of this promising therapy.

References

1. Rodrigues M, Ezzedine K, Hamzavi I, et al; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol. 2017;77(1):1-13. doi:10.1016/j.jaad.2016.10.048
2. Post NF, Ezekwe N, Narayan VS, et al. The use of lasers in vitiligo, an overview. J EurAcad Dermatol Venereol. 2022;36(6):779-789. doi:10.1111/jdv.18005
3. Xie Y, Shi W, Yin W, et al. Assessment of efficacy on the treatment of localized vitiligo with a combination of 308 nm excimer light and 2940 erbium laser: A retrospective study. J Cosmet Dermatol. 2024. doi:10.1111/jocd.16715
4. Noborio R, Nomura Y, Nakamura M, et al. Efficacy of 308-nm excimer laser treatment for refractory vitiligo: a case series of treatment based on the minimal blistering dose. J EurAcad Dermatol Venereol. 2021;35(4):e287-e289. doi:10.1111/jdv.17047
5. Wen X, Hamblin MR, Xian Y, et al. A preliminary study of fractional CO2 laser added to topical tacrolimus combined with 308 nm excimer lamp for refractory vitiligo. Dermatol Ther. 2019;32(1):e12747. doi:10.1111/dth.12747
6. Alexiades-Armenakas MR, Dover JS, Arndt KA. Fractional laser skin resurfacing. J Drugs Dermatol. 2012;11(11):1274-1287.