Sumathy Babitha

A successful helium-neon laser and topical tacrolimus combination therapy in one child with vitiligo

Vitiligo is an acquired pigmentation disorder in which the active melanocytes in the epidermis are lost in the involved skin, whereas immature melanoblasts in the outer root sheath (ORS) of the hair follicle are spared (1). Stimulating these melanoblasts to migrate from the ORS, differentiate, and synthesize melanin would rescue vitiligo (1,2). A 16-month-old child presented with hypopigmented patches over the abdomen and inguinal areas over a 6-month period (FIG. 1A). The lesions were accentuated by the examination under Wood lamp. He was diagnosed as vitiligo and was believed to be too young to treat with NB-UVB, and his mother did not want to use a potent corticosteroid ointment on inguinal areas. After discussing treatment options, his parents agreed to start with twice-weekly He-Ne laser treatment (HLA-2000, Laser Therapy System, Hanil Meditech, Korea). Initial follicular repigmentation was noted after 8 weeks (FIG. 1B). However, the inguinal area was unchanged because the folded area was not exposed to the light (FIG. 1C). Therefore, we carefully exposed the folded area to He-Ne irradiation. After 36 treatments with the He-Ne laser, we added 0.03% topical tacrolimus ointment twice daily to promote repigmentation. After 96 treatments with the He-Ne laser, most of the lesion became repigmented (FIG. 1D,E). The physiologic effects of He-Ne laser treatment are attributed to direct biostimulation, which causes the release of various growth factors and promotes the proliferation of exposed cells (2,3). To evaluate the possible mechanism of vitiligo treatment with a He-Ne laser, we investigated the effect of LED, which is a lowlevel He-Ne laser, on the proliferation, migration, and differentiation of melanoblasts using a mouse melanoblast (Melb-a) cell line. We used an LED array of 660 nm with a power intensity of 4.45 mW/cm. LED exposure was given at four different times. Cell differentiation was measured on the basis of melanin content. Compared with the control group, Melb-a cell proliferation and differentiation were not stimulated by LED irradiation (data not shown). The migratory activity of Melb-a cells was determined by assessing the ability of the cells to cross the 8.0-mm migration chambers in transwell cell culture chambers (Costar 3422; Cambridge, MA, USA). After a 72hour incubation, LED treatment significantly increased the number of migrating melanoblasts compared to a-MSH treatment (FIG. 2). This Address correspondence and reprint requests to: Jeonghyun Shin, MD, PhD, Department of Dermatology, Inha University School of Medicine, 7-206, 27, inhang-ro, Jung-gu, Incheon 400-711, South Korea, or email: jshin@inha.ac.kr. Conflict of interest: None declared.