New York — The excimer laser is proving to be the most effective treatment for vitiligo, at least for dark-skinned patients who are afflicted with the disease on their faces. According to one expert, the condition greatly affects the self-esteem of patients, especially when it’s on the face.

“I’m not aware of another treatment that will reliably repigment patients in as few treatments,” says Mark Lebwohl, M.D., professor and chairman, department of dermatology, Mount Sinai School of Medicine, New York. “Even when the condition is severe, the excimer laser provides dramatically effective results.”

While the excimer laser also improves the condition for patients with vitiligo of the hands and feet, as well as those with light skin, changes are seen less quickly than on the faces of dark-skinned patients, according to Dr. Lebwohl.

“For localized disease, particularly on the face, the excimer laser in combination with a topical calcineurin inhibitor such as tacrolimus or pimecrolimus is the safest, fastest and most effective treatment, in my experience,” he says.

Safety measures

Although the package inserts for these inhibitors warn against concomitant treatment with ultraviolet light — which the excimer laser is — clinical trails have confirmed that the two have been used safely together, according to Dr. Lebwohl.

“The excimer laser can accomplish what other therapies haven’t been able to,” he says. “For instance, some dermatologists use high-dose systemic steroids to treat patients with vitiligo, which does temporarily result in dramatic repigmentation. The problem, however,” he says, “is that you can’t keep a patient on steroids forever, because of the many side effects. When you take patients off the steroids, their vitiligo comes back with a vengeance.”

History of other therapies