Methotrexate Cutaneous Delivery by Fractional CO2 Laser Against 5-Fluorouracil in Stable, Nonsegmental Vitiligo

Being chronic, combination therapies in vitiligo are beneficial, especially in refractory cases. Fractional CO2 laser (FCL) delivery of 5-fluorouracil (5-FU) has been successful in stable vitiligo. Topical methotrexate (MTX) is a potential, safer alternative to systemic route in vitiligo.

To investigate efficacy/safety of FCL with MTX versus 5-FU in stable vitiligo, and to assess serum and lesional interleukin (IL)-23 as possible therapeutic markers.

A total of 42 patients with vitiligo were enrolled. FCL was applied at 50 and 100 mJ energies, followed by topical MTX in group I and 5-FU in group II for 3-monthly sessions. Modified Vitiligo Area Scoring Index (VASI) and photography evaluated response, along with evaluation of serum and lesional interleukin-23 (IL-23).

Both MTX and 5-FU with FCL produced significant reductions, without difference, in VASI. All groups exhibited considerable repigmentation by photography, with earlier response in higher energy FCL+5-FU after treatment and continuous improvement in FCL + MTX at follow-up. Post-treatment reductions in serum and lesional IL-23 occurred in all groups, with greater decrease in serum IL-23 with MTX and lesional IL-23 with higher-energy FCL.

MTX provides comparable efficacy and safety with 5-FU after FCL for stable, nonsegmental vitiligo. IL-23 is a new treatment biomarker in vitiligo.