**Abstract**

Vitiligo is an acquired cutaneous hypopigmentary disorder characterized by multiple depigmented macules and patches. There are numerous therapy modalities consist of topical corticosteroids and calcineurin inhibitors, phototherapy, surgical interventions and laser treatments are evaluated. Last 10 years, firstly excimer laser treatment has showed good results in repigmentation rates. "Excited dimers" produces a 308-nm ultraviolet (UV) monochromatic coherent wavelength, which lies within the UVB spectrum that absorb DNA as a chromophore to breakage DNA chain that causes a decrease in T-lymphocyte proliferation. Some articles have shown different responses depends on the type of vitiligo, number of sessions, interval periods and localisation. Researchers have also compared efficacy and also side effects of excimer laser between other methods. Combination therapies with excimer laser will be also treatment of choice via topical steroids or topical calcineurin inhibitors. Some of the patients developed delayed-onset permanent hypopigmentation need resurfacing methods such as CO2 or Er:YAG laser which mainly aims to ablate the epidermis in specific coagulation columns to promote the penetration of externally applied agent. As an alternative treatment modality in vitiligo, lasers may help to raise patient compliance and reduce potential risk for skin cancer. Its convenience is limited by high cost and accessibility.

**Keywords:** vitiligo, treatment, excimer, laser, refractory, CO2

#### **1. Introduction**

Vitiligo is an autoimmune skin disorder with a 0.5–2.0% incidence worldwide without sex or age. It is characterized by hypopigmented macules and patches due to dysfunction of melanocytes. Etiology of the disease could not elucidated yet. The significant association between vitiligo and other autoimmune diseases, including alopecia areata, diabetes mellitus, Addison's disease, pernicious anemia, Graves' disease, Hashimoto's thyroiditis, systemic lupus erythematosus, rheumatoid arthritis, psoriasis and inflammatory bowel disease. Vitiliginous patches are often psychologically distressing and also have risk to loss of social status so that they cause negative impact of quality of life index. Two major forms are generally recognized that are *segmental* and *nonsegmental* types. Treatment of vitiligo is challenging and consensus of treatment modalities have changed beyond the types and places where the lesions mainstay. There are various phototherapy treatments which consist of PUVA, narrow-band UVB (NUVB), excimer laser and lamp commonly based on stimulation of melanocytes in the outer root sheath of hair follicles and on the margins of lesions besides that residual intralesional melanocytes migrate and repopulate the vitiliginous areas. Topical corticosteroid, calcineurin inhibitors, vitamine E and pseudocatalase could combine with these modalities to increase

**8**

*Depigmentation*

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treatment response. Furthermore in stable vitiligo patients, surgical methods such as full-thickness tissue graft (punch graft), split thickness graft, and suction blister graft, cellular grafts contains cultured melanocytes/keratinocytes have shown promising results [1, 2].
