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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