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Vitiligo is an acquired disorder of the skin and mucous membranes characterized by well circumscribed depigmented macules and patches that occur secondary to selective destruction of melanocytes (Zhang et al., 2009).
Generalized vitiligo is the most common clinical presentation and often involves the face and acral regions (Alikhan et al., 2011).
Combined vitiligo treatments have been found to be superior to monotherapies regarding efficacy, early response and safety (Kandaswamy et al., 2013).
Fractionated lasers represent a new modality for skin resurfacing based on the theory of fractional photothermolysis introduced by Manstein et al (2004). These lasers were shown to be efficient in treating facial photo aging changes as well as scars, and have an improved safety and recovery profile compared with traditional CO2 laser resurfacing. Fractionated lasers do not ablate the entire epidermis and thereafter leave intact skin between coagulated necrotic columns. This characteristic facilitates the skin healing process (Bogdan et al., 2010)
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A (Tacrolimus group): | Experimental | fractional CO2 laser therapy and Tacrolimus ointment 1 |
|
| Group B (Calcipotriol group): | Experimental | fractional CO2 laser therapy and Calcipotriol ointment |
|
| Group C (NB-UVB group): | Experimental | fractional CO2 laser therapy and NB-UVB twice weekly |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tacrolimus ointment | Drug | 3 sessions of fractional CO2 laser one month apart Patients will start treatment Tarolimus ointment twice daily for 3 months. |
|
| Measure | Description | Time Frame |
|---|---|---|
| 1- Re-pigmentation : that will be subjectively rated with a previously reported scoring system (Ghiya et al., 2016). | G0, < 25% repigmentation (poor)
| up to 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| The VASI percent change | The VASI percent change will be calculated by subtracting the pre- procedure VASI score from the post-procedure VASI score and dividing by the pre-procedure VASI score. | every month for 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| - Frequency and types of side effects. | pain, scarring, hyperpigmentation | 3 months |
| - Patient satisfaction. The patient overall satisfaction will be assessed after 6 months according to Wong and Vasconez (2011). Overall satisfaction: |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| yasmin tawfik, MD | Contact | 01006033331 | dr.yasminmostawfik@yahoo.com | |
| reham maher abdel gaber | Contact | 01005043777 | rehamaher707@yahoo.com |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25596811 | Result | Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet. 2015 Jul 4;386(9988):74-84. doi: 10.1016/S0140-6736(14)60763-7. Epub 2015 Jan 15. | |
| 23919018 | Result | Kandaswamy S, Akhtar N, Ravindran S, Prabhu S, Shenoi SD. Phototherapy in Vitiligo: Assessing the Compliance, Response and Patient's Perception about Disease and Treatment. Indian J Dermatol. 2013 Jul;58(4):325. doi: 10.4103/0019-5154.113944. |
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| ID | Term |
|---|---|
| D014820 | Vitiligo |
| ID | Term |
|---|---|
| D017496 | Hypopigmentation |
| D010859 | Pigmentation Disorders |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
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|
| calcipotriol ointment | Drug | 3 sessions of fractional CO2 laser one month apart Patients will start treatment Calcipotriol ointment twice daily for 3 months. |
|
|
| NB-UVB | Drug | 3 sessions of fractional CO2 laser one month apart Patients will start treatment NB-UVB phototherapy twice weekly for 3 months |
|
|
| 3 months |
| 19787413 | Result | Bogdan Allemann I, Kaufman J. Fractional photothermolysis--an update. Lasers Med Sci. 2010 Jan;25(1):137-44. doi: 10.1007/s10103-009-0734-8. |
| 21451378 | Result | Wong L, Vasconez HC. Patient satisfaction after Nd:YAG laser-assisted lipolysis. Ann Plast Surg. 2011 May;66(5):561-3. doi: 10.1097/SAP.0b013e31820b3d1e. |