Severe cases of vitiligo effectively treated by excimer laser

Key Points

New York - The excimer laser is proving to be the most effective treatment for vitiligo, at least for dark-skinned patients who are afflicted with the disease on their faces. According to one expert, the condition greatly affects the self-esteem of patients, especially when it's on the face.

"I'm not aware of another treatment that will reliably repigment patients in as few treatments," says Mark Lebwohl, M.D., professor and chairman, department of dermatology, Mount Sinai School of Medicine, New York. "Even when the condition is severe, the excimer laser provides dramatically effective results."

Safety measures

Although the package inserts for these inhibitors warn against concomitant treatment with ultraviolet light - which the excimer laser is - clinical trails have confirmed that the two have been used safely together, according to Dr. Lebwohl.

"The excimer laser can accomplish what other therapies haven't been able to," he says. "For instance, some dermatologists use high-dose systemic steroids to treat patients with vitiligo, which does temporarily result in dramatic repigmentation. The problem, however," he says, "is that you can't keep a patient on steroids forever, because of the many side effects. When you take patients off the steroids, their vitiligo comes back with a vengeance."

History of other therapies

But sometimes therapies other than excimer lasers may be the first choice. One treatment that was in favor about 15 years ago is PUVA, or psoralen photochemotherapy. Treatments were administered from two to three times a week for years. And then, patients were only partially repigmented, and only a very small portion of those who started the treatment ever stuck with it for years.

This treatment was replaced by narrowband UVB, a safer therapy that is less carcinogenic, with faster results than PUVA.

"If the whole body is affected by vitiligo," Dr. Lebwohl says, "you're going to need a whole-body treatment, such as light treatments, either PUVA or narrowband UVB."

Who has excimer lasers?

Excimer lasers are not available everywhere, and today just a few hundred machines are in use around the country, according to Dr. Lebwohl, whose colleague James Spencer, M.D., patented the use of the excimer laser for use with vitiligo for several years. Mount Sinai department of dermatology physicians have used the excimer laser to treat vitiligo in hundreds of patients since that time.

While the laser is approved by the Food and Drug Administration (FDA) only for psoriasis, its two main indications for use are psoriasis and vitiligo.

Because some insurers consider vitiligo a cosmetic problem, they sometimes refuse to reimburse treatment of this condition.

"This is a debilitating and deforming condition, yet it had been harder to get insurance to reimburse it than for other skin diseases. So that had been somewhat of a limiting factor in the use of the excimer. Many people will pay cash," Dr. Lebwohl says.

Once Medicare approved codes to reimburse use of the laser - which most insurers will pay for psoriasis - more dermatologists acquired the unit, he says.

"Once they have it, they use it for vitiligo, too," he says. "They see how well it works for vitiligo, and they start to build very large practices because it is quite effective … more than anything else that we have."