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a patient with vitiligo came to asking for hair removal.
she has it on the eyelids and elbos , knees for 5 years. inhte last year it is getting mild relapse.
she is currently on NBUVB
my questions are:
1-is it contraindicated to use laser here? can patients koebenrise on laser? even if they dont burn?
2- patient already on phototherapy do we have to adjust for the laser parameters (am using gentilase)
3-if the patent was to develope vitligo on the legs ten years from know, and she did laser epilation now, will that jepperdise her chances for repigmentation since the commonest form of repigmnetation in vitiligo is follicular?
thanks
dermlive
dermis111
dr660
skindr
visitor111
epiderma
kamalsaleh
You might want to read these two articles and make a few inferences although the lasers are different:
1. Monique ThissenMD & * Wiete WesterhofMD. Laser treatment for further depigmentation in vitiligo; Volume 36 Issue 5 Page 386-388, May 1997.
Their results are as follows “In patients with a positive Koebner phenomenon, a permanent state of depigmentation was reached after laser therapy”
2.* Sommer & * Sheehan-Dare. The Koebner phenomenon in vitiligo following treatment of a port-wine stain naevus by pulsed dye laser.Volume 138 Issue 1 Page 200-201, January 1998.
Best wishes,
Reddy
India
These quetions are valid especially the third question which reflects good knowledge about the pathophysiology of vitiligo recovery.
1-I dont have a problem for using laser hairremoval in vitiligo patients, because Kobener phenomenon needs injury to the skin ( mechanical or thermal ) and the degree of thermal injury in laser hair removal is very minima
2-yes you should adjust the dose
3-NO, I DONT think your treatment now will affect hair recovery from vitiligo in case the treated areas developed vitiliginous patches in the future , simply because laser haie removal is not a permanent proscess, hair will regrow after few months and maximum a year of last laser session.
Best Regards
there are 2 papers discussing the use of both ruby and q switch Alex lasers for depigmenting difficult spots in those who didnt respond to benoquine, so laser does cause vitiligo. but the energy used was high and it was thought it induced koebnerisation.
different lasers have different mech of actions am not sure we can generalise that in all lasers.
however, since laser epilation cause semipermanent hair loss, some hair follicles are lost for good(the rest recovers) then theoritcialy it may interfere with repigmentaion in the future. i wouldnt use it