Methotrexate Cutaneous Delivery by Fractional CO2 Laser Against 5-Fluorouracil in Stable, Nonsegmental Vitiligo
Sahar A. Ismail, Aya M. Sayed, Mai M. Elkabsh, Aml A. Rayan, Marwa M. MekkawyBACKGROUND
Being chronic, combination therapies in vitiligo are beneficial, especially in refractory cases. Fractional CO2 laser (FCL) delivery of 5-fluorouracil (5-FU) has been successful in stable vitiligo. Topical methotrexate (MTX) is a potential, safer alternative to systemic route in vitiligo.
OBJECTIVE
To investigate efficacy/safety of FCL with MTX versus 5-FU in stable vitiligo, and to assess serum and lesional interleukin (IL)-23 as possible therapeutic markers.
MATERIALS AND METHODS
A total of 42 patients with vitiligo were enrolled. FCL was applied at 50 and 100 mJ energies, followed by topical MTX in group I and 5-FU in group II for 3-monthly sessions. Modified Vitiligo Area Scoring Index (VASI) and photography evaluated response, along with evaluation of serum and lesional interleukin-23 (IL-23).
RESULTS
Both MTX and 5-FU with FCL produced significant reductions, without difference, in VASI. All groups exhibited considerable repigmentation by photography, with earlier response in higher energy FCL+5-FU after treatment and continuous improvement in FCL + MTX at follow-up. Post-treatment reductions in serum and lesional IL-23 occurred in all groups, with greater decrease in serum IL-23 with MTX and lesional IL-23 with higher-energy FCL.
CONCLUSION
MTX provides comparable efficacy and safety with 5-FU after FCL for stable, nonsegmental vitiligo. IL-23 is a new treatment biomarker in vitiligo.