CO2 laser and microneedling for vitiligo

Fractional CO2 laser and microneedling are used alongside phototherapy to treat vitiligo in areas that resist standard treatment, such as the hands and feet. Both create tiny controlled injuries in the skin, which may stimulate pigment cells and help topical medicines reach them. A randomised trial co-authored by Professor Nilforoushzadeh compared the two.

How was the trial set up?

The 2024 trial enrolled 84 people with non-segmental vitiligo and treatment-resistant patches. All received standard treatment, NB-UVB phototherapy and a strong topical steroid (clobetasol), and one of two add-ons, fractional CO2 laser or microneedling, applied to symmetrical patches so each person served as their own comparison. Treatment lasted 16 weeks, with follow-up to six months.

What did it find?

• Patches treated with fractional CO2 laser or microneedling regained significantly more pigment than patches treated without them.
• The pattern of repigmentation was similar, with slightly more repigmentation from the edges with microneedling.
• Pain, burning and redness were more common with the add-ons, without a significant difference between laser and microneedling; itching and crusting differed between the groups.
• Patient satisfaction was comparable.

The authors conclude that combining NB-UVB and topical steroid with either add-on seems effective in resistant areas, and that the choice should take account of the patient and the body site.

Does wider evidence agree?

A 2022 meta-analysis of surgical vitiligo treatments found benefits from adding ablative laser or microneedling to NB-UVB, with few adverse effects. For stable patches that still do not respond, cell transplantation (MKTP) is a further option. The vitiligo guide explains how these steps fit together.