Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Dermatology, St. Vincent's Hospital, Seoul, South Korea.
Arch Dermatol Res. 2023 Oct;315(8):2289-2294. doi: 10.1007/s00403-023-02611-8. Epub 2023 Mar 25.
Vitiligo patients may desire laser hair removal, skin rejuvenation, vascular treatments, and other laser or intense pulsed light (IPL) assisted treatments. However, there is a risk of inducing new depigmented patches (Koebner phenomenon). In absence of guidelines on the safe use of laser or IPL in vitiligo patients, dermatologists tend to be reluctant to administer these treatments. The aim of this survey study was to provide an estimation of the occurrence and related risk factors of laser/IPL-induced leukoderma or vitiligo. A cross-sectional survey study was performed among 15 vitiligo experts from 11 countries, with 14 questions about affected patients, involved laser/IPL treatments and the physicians' approach. In a total of 11,300 vitiligo patients, laser/IPL-induced leukoderma or vitiligo was reported in 30 patients (0.27%). Of these, 12 (40%) patients had a medical history of vitiligo and seven (58%) of these patients had stable (> 12 months) vitiligo before the treatment. Most frequently reported were hair removal procedures and localization of the face and legs. Side effects like blistering, crusting, and erosions occurred in 56.7% of the cases. These vitiligo experts based their advice on the risk of the laser treatment on stability of the vitiligo (43%) and activity signs (50%), and 50% discuss the risks before starting a laser treatment. Relevant activity signs are the Koebner phenomenon (57.1%), confetti-like lesions (57.1%) and hypochromic borders (50%). Laser-induced leukoderma or vitiligo is an uncommon phenomenon. Remarkably, a minority had a medical history of vitiligo of which 58% were stable. Consequently, most cases could not have been prevented by not treating vitiligo patients. However, a majority had laser/IPL-induced skin damage. Therefore, caution is advised with aggressive settings and test-spots prior to the treatment are recommended. This study showed significant variation in the current recommendations and approach of vitiligo experts regarding laser/IPL-induced leukoderma or vitiligo.
白癜风患者可能希望接受激光脱毛、皮肤年轻化、血管治疗和其他激光或强脉冲光 (IPL) 辅助治疗。然而，这存在诱导新的色素脱失斑块（Koebner 现象）的风险。由于缺乏关于白癜风患者安全使用激光或 IPL 的指南，皮肤科医生往往不愿意进行这些治疗。本调查研究旨在评估激光/ IPL 诱导的色素减退或白癜风的发生和相关危险因素。在来自 11 个国家的 15 名白癜风专家中进行了一项横断面调查研究，共有 14 个关于受影响患者、涉及的激光/ IPL 治疗以及医生方法的问题。在总共 11300 名白癜风患者中，报告了 30 名患者（0.27%）出现激光/ IPL 诱导的色素减退或白癜风。其中，12 名（40%）患者有白癜风病史，其中 7 名（58%）患者在治疗前患有稳定（>12 个月）的白癜风。报告最多的是脱毛程序和面部和腿部定位。56.7%的病例出现水疱、结痂和糜烂等副作用。这些白癜风专家根据白癜风的稳定性（43%）和活动迹象（50%）来为激光治疗的风险提供建议，并在开始激光治疗前与 50%的患者讨论风险。相关的活动迹象是 Koebner 现象（57.1%）、雪花样病变（57.1%）和色素减退边界（50%）。激光诱导的色素减退或白癜风是一种罕见现象。值得注意的是，少数患者有白癜风病史，其中 58%为稳定期。因此，大多数病例本来是可以通过不治疗白癜风患者来预防的。然而，大多数情况下发生了激光/ IPL 诱导的皮肤损伤。因此，建议谨慎使用激进的设置，并建议在治疗前进行测试点。本研究显示，白癜风专家在激光/ IPL 诱导的色素减退或白癜风方面的建议和方法存在显著差异。
