Therapeutic Efficacy of 308-nm Excimer Laser Combined with Matrine in Vitiligo by Modulation of Serum Immunoglobulins and Inflammatory Cytokines.

Vitiligo is a chronic autoimmune depigmenting disorder characterized by the loss of functional melanocytes and aberrant immune activation. Despite advances in phototherapy, clinical responses remain inconsistent, largely due to persistent inflammatory activity and inadequate immune regulation. This study investigated the therapeutic efficacy and immunologic mechanisms of combining 308-nm excimer laser phototherapy with oral matrine, a natural alkaloid possessing anti-inflammatory and immunoregulatory properties. A total of 232 patients with non-segmental vitiligo were prospectively assigned to receive either excimer laser monotherapy or combination therapy for 12 weeks. Clinical improvement was evaluated using the Vitiligo Area Scoring Index (VASI), and serum immunoglobulins and cytokines were analyzed to assess systemic immune modulation. Both regimens produced significant repigmentation, yet the combination therapy achieved a more pronounced VASI reduction (from 9.72 ± 3.24 at baseline to 5.76 ± 2.18 after treatment) than the excimer laser alone (from 9.68 ± 3.37 to 6.63 ± 2.34, p < 0.001). The proportion of patients demonstrating excellent or good repigmentation was notably higher with the combined regimen (76.7%) compared with monotherapy (58.7%). In parallel, serum IgG levels declined markedly (13.72 ± 2.64 g/L to 11.85 ± 2.18 g/L, p < 0.001), whereas IgA levels rose modestly (2.07 ± 0.68 g/L to 2.23 ± 0.61 g/L, p = 0.041). Pro-inflammatory cytokines including IFN-γ and IL-17 were significantly reduced (both p < 0.001), while anti-inflammatory IL-10 increased from 8.3 ± 3.2 to 12.9 ± 3.5 pg/mL (p < 0.001). VASI improvement correlated inversely with IFN-γ (r = -0.482, p < 0.05) and IL-17 (r = -0.451, p < 0.001) changes, and positively with IL-10 elevation (r = 0.503, p < 0.001). These findings demonstrate that matrine enhances excimer laser efficacy by promoting melanocyte regeneration and restoring immune equilibrium, establishing a biomarker-based dual-modality strategy for precise and durable management of vitiligo.