International journal of dermatology · 2025
308 nm Excimer Laser Combined With JAK Inhibitors for Adult Localized Non-Segmental Vitiligo: A Multicenter Randomized Controlled Trial.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Qi Zuoyao, Zhang Lin, Chang Shuying, Guo Shuxian, Zhang Yaxin, Jiang Guan
Аннотация
BACKGROUND: Vitiligo is an acquired depigmenting skin disorder characterized by autoimmune-mediated melanocyte destruction, leading to well-defined depigmented macules and patches. Localized non-segmental vitiligo poses a significant therapeutic challenge.
METHODS: A total of 251 patients with localized refractory non-segmental vitiligo were randomized into four groups: combination therapy group (308 nm excimer laser + Janus kinase [JAK] inhibitors, n = 63), JAK inhibitor monotherapy group (n = 63), 308 nm excimer laser group (n = 63), and positive control group (n = 62). Treatment lasted 52 weeks. Therapeutic responses were assessed using the Vitiligo Area Scoring Index (VASI) and dermoscopy before and after treatment. Mixed-effects models compared efficacy and analyzed influencing factors. Fisher's exact test compared efficacy among groups and sites; Kruskal-Wallis test assessed melanocyte island density changes; chi-square test evaluated pigmentation stability and recurrence at the 1-year follow-up.
RESULTS: Combination therapy with 308 nm excimer laser and oral JAK inhibitor baricitinib showed significantly greater efficacy than monotherapy and conventional treatment, with a 14.20% higher repigmentation rate than the positive control group (p < 0.001), indicating synergistic effects. By Week 4, patients with melanocyte island density ≥ 5/cm2 had markedly better repigmentation, supporting dermoscopy as an early predictive and monitoring tool. Mixed-effects analysis showed higher repigmentation in facial versus non-facial lesions, females vs. males, and reduced efficacy with longer disease duration. At the 1-year follow-up, combination therapy maintained stable pigmentation with no recurrence.
CONCLUSION: The combination of 308 nm excimer laser and JAK inhibitors significantly enhances repigmentation efficiency in adult localized non-segmental vitiligo, particularly in patients with shorter disease duration and early formation of pigment islands.
METHODS: A total of 251 patients with localized refractory non-segmental vitiligo were randomized into four groups: combination therapy group (308 nm excimer laser + Janus kinase [JAK] inhibitors, n = 63), JAK inhibitor monotherapy group (n = 63), 308 nm excimer laser group (n = 63), and positive control group (n = 62). Treatment lasted 52 weeks. Therapeutic responses were assessed using the Vitiligo Area Scoring Index (VASI) and dermoscopy before and after treatment. Mixed-effects models compared efficacy and analyzed influencing factors. Fisher's exact test compared efficacy among groups and sites; Kruskal-Wallis test assessed melanocyte island density changes; chi-square test evaluated pigmentation stability and recurrence at the 1-year follow-up.
RESULTS: Combination therapy with 308 nm excimer laser and oral JAK inhibitor baricitinib showed significantly greater efficacy than monotherapy and conventional treatment, with a 14.20% higher repigmentation rate than the positive control group (p < 0.001), indicating synergistic effects. By Week 4, patients with melanocyte island density ≥ 5/cm2 had markedly better repigmentation, supporting dermoscopy as an early predictive and monitoring tool. Mixed-effects analysis showed higher repigmentation in facial versus non-facial lesions, females vs. males, and reduced efficacy with longer disease duration. At the 1-year follow-up, combination therapy maintained stable pigmentation with no recurrence.
CONCLUSION: The combination of 308 nm excimer laser and JAK inhibitors significantly enhances repigmentation efficiency in adult localized non-segmental vitiligo, particularly in patients with shorter disease duration and early formation of pigment islands.