Fractional CO₂ laser combined with topical compound betamethasone for Vitiligo-Associated Leukotrichia: a retrospective study of 13 patients with limited effectiveness

Purpose: To evaluate the effectiveness and safety of fractional CO₂ laser combined with topical compound betamethasone for treating vitiligo-associated leukotrichia (VAL). Methods: A total of 13 patients with VAL (a total of 20 lesions) were enrolled; patients who were in rapid-progressing phase (VIDA=4) were excluded. Patients received fractional CO₂ laser following immediate topical application of compound betamethasone every 4 weeks. All patients underwent a minimum of 3 laser treatment sessions, with the number of sessions ranging from 3 to 8 per patient. Treatment outcomes were assessed using global photograph assessment (GPA)-scale, standardized repigmentation grading (G0–G5), and dermoscopic evaluations of hair density and type. Adverse events were also assessed during the 4 weeks post each session. Results: Only 1 patient (7.7%) achieved significant hair repigmentation (grade G4), while 2 others showed mild repigmentation in the vitiligo patches (grade G1). No significant changes in hair counts or densities were observed on dermoscopy after treatment (all p > 0.2). Transient erythema and pain occurred in all patients, and mild desquamation in 15%, all resolving within 2 weeks. No cases of skin atrophy were noted. Conclusion: In this small cohort, fractional CO₂ laser plus topical betamethasone produced minimal hair repigmentation in VAL but was well tolerated. The poor effectiveness may reflect depletion of follicular melanocyte reserves or suboptimal treatment parameters; further controlled studies are needed.