COMPARATIVE STUDY TO EVALUATE THE EFFICACY OF FRACTIONAL CO₂ LASER + PRP VERSUS FRACTIONAL CO₂ LASER ALONE IN PATIENTS WITH VITILIGO
Keywords:
Vitiligo, fractional CO₂ laser, platelet-rich plasma, epigmentation, dermatological therapyAbstract
ackground: Vitiligo is a chronic depigmenting disorder characterized by the loss of functional melanocytes, leading to significant cosmetic and psychological impact. Fractional CO₂ laser therapy has emerged as an effective modality for inducing repigmentation through stimulation of melanocyte migration. Platelet-rich plasma (PRP), rich in growth factors, has been shown to enhance tissue regeneration and melanocyte activity. Combining these modalities may provide synergistic therapeutic benefits. Aim: To compare the efficacy of fractional CO₂ laser combined with platelet-rich plasma (PRP) versus fractional CO₂ laser alone in the treatment of patients with vitiligo.
Methods: This comparative study was conducted over 12 months in a tertiary care dermatology center and included 120 patients with stable vitiligo. Participants were randomly divided into two groups: Group A received fractional CO₂ laser combined with PRP, while Group B received fractional CO₂ laser alone. Clinical evaluation was performed using repigmentation percentage, onset of repigmentation, physician global assessment, and documentation of adverse effects.
Results: Combination therapy demonstrated superior outcomes compared to laser alone. A higher proportion of patients in Group A achieved greater than 50% and greater than 75% repigmentation. Earlier onset of repigmentation was also observed in the combination group. Site-wise analysis showed better response in facial and truncal lesions, while acral areas exhibited comparatively lower response in both groups. Both treatments were well tolerated with only mild and transient adverse effects.
Conclusion: Fractional CO₂ laser combined with PRP is more effective than fractional CO₂ laser alone in achieving repigmentation in patients with stable vitiligo. The combination therapy provides enhanced clinical response with an acceptable safety profile, making it a promising therapeutic option.
References
1. Kadry M, Tawfik A, Abdallah N, Badawi A, Shokeir H. Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study. Clin Cosmet Investig Dermatol. 2018 Nov 8;11:551-559. doi: 10.2147/CCID.S178817. PMID: 30510437; PMCID: PMC6231433.
2. Omar SS, Elmulla KF, Aly RG, Elkaffas A, Ismail A. A triple combination of latanoprost, fractional CO2 laser, and platelet-rich plasma in localized vitiligo: A clinical and histopathologic study. Photodermatol Photoimmunol Photomed. 2024 Jan;40(1):e12944. doi: 10.1111/phpp.12944. PMID: 38288773.
3. Ahlawat S, Kothiwala R, Meherda A. A Comparative Study to Evaluate the Efficacy of Fractional CO2 Laser + PRP Vs. Fractional CO2 Laser Alone in Patients with Vitiligo. J Cutan Aesthet Surg. 2023 Jul-Sep;16(3):186-191. doi: 10.4103/JCAS.JCAS_103_22. PMID: 38189059; PMCID: PMC10768947.
4. Rageh MA, Elrewiny EM, Kadah AS, Zakaria HB, Abdelshakour M, Mohy SM, Mahmoud WA, Suliman AA, Mohamed AA. Fractional CO2 laser with topical insulin versus PRP for atrophic acne scars: a randomized split-face study. Arch Dermatol Res. 2025 Apr 1;317(1):663. doi: 10.1007/s00403-025-04112-2. PMID: 40167803.
5. Kim HJ, Hong ES, Cho SH, Lee JD, Kim HS. Fractional Carbon Dioxide Laser as an "Add-on" Treatment for Vitiligo: A Meta-analysis with Systematic Review. Acta Derm Venereol. 2018 Feb 7;98(2):180-184. doi: 10.2340/00015555-2836. PMID: 29110015.
6. Wu N, Sun H, Sun Q, Cong L, Liu C, Zheng Y, Ma L, Cong X. A meta-analysis of fractional CO2 laser combined with PRP in the treatment of acne scar. Lasers Med Sci. 2021 Feb;36(1):1-12. doi: 10.1007/s10103-020-03105-z. Epub 2020 Aug 10. PMID: 32827074.
7. Kim WI, Kim S, Lee SH, Cho MK. The efficacy of fractional carbon dioxide laser combined with narrow-band ultraviolet B phototherapy for non-segmental vitiligo: a systematic review and meta-analysis. Lasers Med Sci. 2021 Feb;36(1):165-173. doi: 10.1007/s10103-020-03069-0. Epub 2020 Jun 23. PMID: 32572662.
8. Sun J, Yan M, Xu M, Wang T, Li J. Meta-analysis of the efficacy of 308 nm excimer light combined with CO2 fractional laser in the treatment of vitiligo on trunk part. Medicine (Baltimore). 2025 Sep 19;104(38):e44377. doi: 10.1097/MD.0000000000044377. PMID: 40988292; PMCID: PMC12459493.
9. Abou-Taleb HA, Mohamed MS, Zayed GM, Abdelaty LN, Makki MA, Abdel-Aleem HL, El-Mokhtar MA, Hetta HF, Abdullah N, Saddik MS. HPMC-Zein Film-forming Gel Loaded with 5-Fluorouracil Coupled with CO2 Laser Dermabrasion for Managing Stable Vitiligo. AAPS PharmSciTech. 2024 Sep 26;25(7):225. doi: 10.1208/s12249-024-02937-0. PMID: 39327349.
10. Sayed DS, Badary DM, Ali RA, Abou-Taleb DAE. Combined Fractional CO 2 Laser With Intradermal Platelet-Rich Plasma versus Fractional CO 2 Laser Alone in the Treatment of Striae Distensae. Dermatol Surg. 2023 Jun 1;49(6):552-558. doi: 10.1097/DSS.0000000000003763. Epub 2023 Mar 21. PMID: 36946771.
11. Doghaim NN, Gheida SF, El-Tatawy RA, Mohammed Ali DA. Combination of fractional carbon dioxide laser with narrow band ultraviolet B to induce repigmentation in stable vitiligo: A comparative study. J Cosmet Dermatol. 2019 Feb;18(1):142-149. doi: 10.1111/jocd.12553. Epub 2018 Apr 30. PMID: 29707867.
12. Seoudy WM, El Messallamy HS, Youssef SS, Zaki MSE. Fractional carbon dioxide laser versus combined fractional CO2 laser and platelet rich plasma in treatment of facial wrinkles: A comparative split face study. J Cosmet Dermatol. 2023 Mar;22(3):837-849. doi: 10.1111/jocd.15500. Epub 2022 Nov 14. PMID: 36374507.
13. Zhou L, Chen C. Efficacy and safety of fractional CO2 laser combined with 308 nm excimer laser in non-segmental vitiligo: a meta-analysis with trial sequential analysis. J Cosmet Laser Ther. 2025 Apr 3;27(3):87-94. doi: 10.1080/14764172.2025.2485325. Epub 2025 Apr 1. PMID: 40169273.
14. Hui Q, Chang P, Guo B, Zhang Y, Tao K. The Clinical Efficacy of Autologous Platelet-Rich Plasma Combined with Ultra-Pulsed Fractional CO2 Laser Therapy for Facial Rejuvenation. Rejuvenation Res. 2017 Feb;20(1):25-31. doi: 10.1089/rej.2016.1823. Epub 2016 Jun 23. PMID: 27222038; PMCID: PMC5314998.
15. Sany I, Mohamed Sobhi R, Badawi A, Mohamed Elmaadawi Z, Mostafa PIN. Comparative Study Between the Efficacy of Fractional CO2 Laser/Radiofrequency, PRP and a Combination of Both in the Treatment of Striae Distensae: A Pilot Study. Clin Cosmet Investig Dermatol. 2022 Aug 19;15:1687-1694. doi: 10.2147/CCID.S365952. PMID: 36017418; PMCID: PMC9398515.
16. Kadry M, Tawfik A, Abdallah N, Badawi A, Shokeir H. Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study. Clin Cosmet Investig Dermatol. 2018 Nov 8;11:551-559. doi: 10.2147/CCID.S178817. PMID: 30510437; PMCID: PMC6231433.
17. Afify AA, Zuelfakkar NM, Eshafi MA. Fractional CO2 laser, platelet rich plasma and narrow band ultraviolet B in the treatment of Vitiligo (A randomized clinical trial). Lasers Med Sci. 2021 Sep;36(7):1479-1486. doi: 10.1007/s10103-020-03195-9. Epub 2020 Nov 25. PMID: 33236202.
18. Sharma S, Kaur J, Kaur T, Bassi R. Fractional Carbon Dioxide Laser versus Combined Fractional Carbon Dioxide Laser with Platelet-rich Plasma in the Treatment of Atrophic Post-acne Scars: A Split-face Comparative Study. J Cutan Aesthet Surg. 2021 Jan-Mar;14(1):41-46. doi: 10.4103/JCAS.JCAS_147_19. PMID: 34084007; PMCID: PMC8149982.
19. Galal O, Tawfik AA, Abdalla N, Soliman M. Fractional CO2 laser versus combined platelet-rich plasma and fractional CO2 laser in treatment of acne scars: Image analysis system evaluation. J Cosmet Dermatol. 2019 Dec;18(6):1665-1671. doi: 10.1111/jocd.12909. Epub 2019 Apr 9. PMID: 30964227.
20. Preclaro IAC, Tianco EAV, Buenviaje-Beloso M. Efficacy of ablative fractional carbon dioxide laser combined with autologous platelet-rich plasma versus ablative fractional carbon dioxide laser and placebo in the treatment of striae gravidarum: A randomized clinical trial. J Cosmet Dermatol. 2022 Oct;21(10):4354-4364. doi: 10.1111/jocd.14791. Epub 2022 Feb 9. PMID: 35075752.
