الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Vitiligo is an acquired autoimmune disorder of pigmentation that occurs due to loss of epidermal melanocytes and presented clinically by depigmented macules and patches. It affects nearly 0.5%‐1% of the population.
Vitiligo is a multifactorial polygenic disease with a complex pathogenesis. It is related to both genetic and non genetic factors, involving the interplay of multiple factors, many of which are unknown.
Vitiligo has been classified based on clinical grounds into two major forms, segmental vitiligo (SV) and non-segmental vitiligo (NSV), the latter including several variants (generalized, acrofacial and universal).
Despite numerous available treatment options, a high proportion of patients with vitiligo have resistant disease Therefore, multidisciplinary therapeutic approaches are required.
The NB-UVB phototherapy has been considered a very important modality in treatment of vitiligo since its first use in 1997.It was proved to be effective, and safe therapy for vitiligo, but the treatment course often requires a long duration of time with a potential risk for various side effects and patients’ noncompliance.
Fractionated ablative laser represents a new modality for skin resurfacing. It has a better safety and recovery profile compared with traditional carbon dioxide laser resurfacing.
The propsed mechanisms of action of carbon dioxide fractional laser in repigmentation include: producing local inflammation resulting from the thermal energy generated on the skin that promote the proliferation of melanocytes (similar to mechanism of pigmentation after inflammation).Also locally produced cytokines and growth factors cause melanocytes migration from the hair follicle and nearby normal skin to the skin defect. Laser can immediately cause tissue shrinkage that reduce the size of vitiligo lesions. Laser also increases penetration of topical drugs and ultraviolet (UV) radiation.
Platelet‐rich plasma (PRP) is an autologous preparation of concentrated platelets in small volume of plasma,resulting in concentration of multiple growth factors. This group of GFs stimulate keratinocytes and fibroblasts proliferation with subsequent improvement of their interaction with melanocytes leading to stabilization of melanocytes. PRP is considered an excellent safety profile with relatively low cost.
The study aimed to compare the effect of fractional carbon dioxide laser therapy combined with PRP injection versus fractional carbon dioxide alone on the outcome of NB-UVB phototherapy in treatment of stable vitiligo.
The study was conducted on 47 patients with stable non-segmental vitiligo. Seventeen patients underwent NB-UVB phototherapy sessions twice per week. Fifteen patients received NB-UVB phototherapy and fractional co2 laser sessions once every 3 weeks. Fifteen patients received NB-UVB phototherapy twice per week, fractional co2 laser once every 3 weeks and PRP intradermal injection once every 2 weeks.
The three groups were matched according to sex, age, occupation, skin type,family history, type of vitiligo,, age at time of onset of vitiligo, duration of disease, body surface area affected, size and site of vitiligo patch treated.