Acta Demato-Venereologica 98-2CompleteContent | Page 8

180 REVIEW ARTICLE Fractional Carbon Dioxide Laser as an “Add-on” Treatment for Vitiligo: A Meta-analysis with Systematic Review Hyun Jung KIM 1 , Eun Sun HONG 2 , Sang Hyun CHO 2 , Jeong Deuk LEE 2 and Hei Sung KIM 2 Department of Preventive Medicine, Korea University College of Medicine, Seoul, and 2 Department of Dermatology, Incheon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea 1 Treatment of vitiligo is challenging and requires a multidisciplinary approach. Fractional carbon dioxide (CO 2 ) laser as an add-on to conventional treatment has been reported to be effective, but there is no consen- sus on its use. A systematic review was performed by searching major databases for relevant publications to February 2017. Six studies with 85 participants were included. For those with refractory vitiligo, the addition of fractional CO 2 laser to routine treatment modalities was superior to conventional treatment alone in terms of > 50% re-pigmentation (risk ratio (RR) 4.90, 95% confidence interval (95% CI), 1.15– 20.93; p  = 0.03), physician improvement score (mean difference (MD) 0.81, 95% CI 0.33–1.29; p  < 0.001), < 25% re-pigmentation (RR 0.64, 95% CI 0.49–0.85; p=0.002) and patient satisfaction (MD 1.61, 95% CI 0.73–2.49; p  < 0.001). Side-effects were minor. These results provide evidence supporting that fractional CO 2 laser is a valuable treatment modality for patients with vitiligo, especially for those with refractory vitiligo. Key words: fractional CO 2 laser; add-on treatment; vitiligo; re- fractory vitiligo; systematic review; meta-analysis. vitiligo (3–12). Fractionated ablative laser represents a new modality for skin resurfacing based on the theory of fractional photothermolysis (13). It is efficient in treating facial photo-aging and scars, and has an improved safety and recovery profile compared with traditional CO 2 la- ser resurfacing. The beneficial effect of fractional CO 2 laser on vitiligo is postulated to come from the release of cytokines and growth factors that act as mitogens for melanogenesis (3). The preceding laser also alters the skin barrier, which results in increased penetration of topical drugs and ultraviolet (UV) radiation (4). While the use of fractional CO 2 laser followed by nar- row-band ultraviolet B (NB-UVB), sunlight exposure, or topical agents has demonstrated promising