Laser and Bimatoprost Combination Therapy Improve Facial Vitiligo

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Affecting 0.05% to 2% of the population, vitiligo has a substantial psychological and social impact.^1,2 Many individuals with vitiligo experience mental health challenges, including anxiety, depression, and low self-esteem, particularly when the depigmentation is on visible areas such as the face.³ Various treatments, including topical corticosteroids, calcineurin inhibitors, phototherapy, and surgical options, have been explored to manage the disease. However, due to the complex, multifactorial nature of vitiligo, treatment efficacy varies among patients, necessitating new combination therapies.⁴

The 308-nm excimer laser (EL) is an FDA-approved phototherapy device widely used for vitiligo treatment. It delivers targeted UV radiation to affected areas, minimizing exposure to surrounding healthy skin. However, some patients exhibit resistance to EL treatment alone, prompting the need for combination therapies.⁵ Bimatoprost 0.03%, a prostaglandin F2α analog known for inducing melanogenesis, has been studied for its potential efficacy in vitiligo treatment.⁶ Researchers behind a recent study aimed to evaluate whether combining EL with bimatoprost 0.03% enhances repigmentation outcomes compared to EL monotherapy.⁷

“Combining 308-nm EL with topical bimatoprost 0.03% significantly enhances treatment outcomes for facial vitiligo, as evidenced by higher Vitiligo Area Scoring Index (VASI), Visual Analog Scale for Satisfaction (VASS), and Scale for Improvement Assessment (SAI) scores compared to EL alone,” researchers wrote.

Methods

This single-blind randomized clinical trial was conducted at Razi Hospital, Tehran, between 2021 and 2022. The study recruited 38 adults over 20 years old with at least 1 untreated facial vitiligo patch for a minimum of 3 months. Participants were randomly assigned to either the intervention group (EL combined with daily topical bimatoprost 0.03%) or the control group (EL alone).

EL treatment was administered twice weekly for 15 weeks, starting at 100 mJ/cm² and increasing by 10% per session. Patients in the intervention group applied bimatoprost 0.03% solution once daily. Treatment adherence was monitored through patient diaries and solution volume assessments at follow-ups. Outcomes were evaluated using the VASI for repigmentation, the VASS, and the SAI for objective physician assessment. Statistical analysis was conducted using MANOVA, adjusting for baseline variables and age, with significance set at p<0.05.

Results

Researchers stated the demographic characteristics of the 2 groups were comparable, as well as the disease duration.According to the study, the intervention group showed significantly greater improvements in all outcome measures. VASI improvement was evident after 10 treatment sessions (p=0.002), while VASS scores were significantly higher at 20 and 30 sessions (p≤0.001). SAI assessments confirmed superior repigmentation in the intervention group compared to the control group (p≤0.001).

The study stated adverse events were minimal and comparable between groups. Three patients in the intervention group experienced hypertrichosis, while 1 had erythema. In the control group, 2 patients reported erythema. No severe adverse events necessitated treatment discontinuation.

Conclusion

The study found the combination of 308-nm EL and topical bimatoprost 0.03% significantly enhanced facial vitiligo repigmentation and patient satisfaction compared to EL alone. This suggests that bimatoprost may be a valuable adjunct therapy in vitiligo management. These findings align with previous research supporting combination treatments for vitiligo. Given the observed benefits and the absence of major adverse events, researchers stated clinicians should consider this approach for patients who do not respond adequately to EL monotherapy.

However, the study has limitations, including a relatively small sample size, single-center design, and a follow-up period of only 15 weeks. Researchers stated future multi-center trials with larger cohorts and extended follow-up durations are recommended to confirm long-term efficacy and safety. Additionally, incorporating placebo-controlled comparisons could further strengthen the findings. Overall, the study provided promising evidence supporting the use of combined EL and bimatoprost therapy for facial vitiligo treatment.

References

1. Krüger C, Schallreuter KU. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. Int J Dermatol. 2012;51(10):1206-1212. doi:10.1111/j.1365-4632.2011.05377.x
2. Sarkar S, Sarkar T, Sarkar A, Das S. Vitiligo and psychiatric morbidity: A profile from a vitiligo clinic of a rural-based tertiary care center of Eastern India. Indian J Dermatol. 2018;63(4):281-284. doi:10.4103/ijd.IJD_142_18
3. Rzepecki AK, McLellan BN, Elbuluk N. Beyond traditional treatment: The importance of psychosocial therapy in vitiligo. J Drugs Dermatol. 2018;17(6):688-691.
4. Feng Y, Lu Y. Advances in vitiligo: Update on therapeutic targets. Front Immunol. 2022;13:986918. Published 2022 Aug 31. doi:10.3389/fimmu.2022.986918
5. Guo C, Gu X, Zhang J, et al. Efficacy of fire needle combined with 308 nm excimer laser therapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials. J Cosmet Dermatol. 2024;23(8):2592-2602. doi:10.1111/jocd.16308
6. Silpa-Archa N, Likittanasombat S, Apinuntham C, et al. The efficacy of bimatoprost ophthalmic solution combined with NB-UVB phototherapy in non-segmental and segmental vitiligo: a single-blind randomized controlled study. Sci Rep. 2023;13(1):6438. Published 2023 Apr 20. doi:10.1038/s41598-023-32591-8
7. Ghiasi M, Isazade A, Marhamati T, et al. The efficacy of 308-nm excimer laser with topical bimatoprost 0.03% for facial vitiligo. J Cosmet Dermatol. 2025;24(2):e70020. doi:10.1111/jocd.70020