الفهرس 
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Abstract
Vitiligo is an acquired skin disorder characterized by depigmented macules and patches due to the loss of functioning melanocytes in the skin, with a global prevalence around 1% (Alikhan et al., 2011). Vitiligo does not produce direct physical impairment ; however, it has a negative social and psychological impact on the afflicted patients when the depigmented lesions occur in exposed areas, such as face, neck, and extremities (Van Geel et al., 2017). The pathophysiologic theory remain unclear. Various pathogenetic concepts have been proposed and supported by many studies. Autoimmunity, oxidative stress, acumulation of toxic compounds, infections, mutations, alter cellular environment, melanocytorrhagy, and impaired melanocyte migration and survival can all contribute to the patho-physiologic processes of vitiligo (Speeckaert and van Geel, 2017). Vitiligo is classified into segmental vitiligo (SV), non segmental vitiligo (NSV) and mixed vitiligo. In non-segmental vitiligo (NSV) there is usually some form of symmetry in the location of the patches of depigmentation. New patches also appear over time and can be generalized over large portions of the body or localized to a particular area. It is classified further into generalized vitiligo (the most common pattern, wide and randomly distributed areas of depigmentation), universal vitiligo, focal vitiligo, acro-facial vitiligo and mucosal vitiligo (wolff et al., 2008). Multiple treatment modalities are established but the response is variable (Taieb & Picardo, 2007). This problem is exaggerated by the multifactorial and polygenic nature of the patho-mechanism of the disease (Eleftheriadou et al., 2011). Platelet-rich plasma (PRP) is composed of high concentration of platelets with high concentration of growth factors (GFs) (Abuaf et al., 2016). This may help in stimulation of the proliferation of melanocytes and repigmentation within vitiliginous patches (Ibrahim et al., 2016). Fractional CO2 laser has been introduced as an add-on treatment of vitiligo (Shin et al., 2012). The beneficial effect of fractional CO2 laser on vitiligo is postulated to come from the release of cytokines and growth factors that act as mitogens for melanogenesis (Williams et al., 2016), also alters the skin barrier which results in increased penetration of topical drugs and ultraviolet (UV) radiation (Vachiramon et al., 2016). These facts pave the way to combination therapy that showed better repigmentation response than monotherapy (Whitton et al., 2016). Several combination therapies have been introduced to obtain better results and to reduce risks (Tsuchiyama et al., 2016). The prolonged duration of therapy is the main reason for patient noncompliance (Whitton et al., 2016). The Aim of this study: The aim of the present study Is to asses the efficacy of platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of stable non segmental vitiligo lesions Materials and methods : This study was 20 patients presenting with stable, non-progressive non segmental vitiligo (NSV). For each patient one side of the body was treated with PRP, while the other side was treated with Fractional CO2 laser and PRP. Patients received 6 treatment sessions with 2- week interval for 2.5 months and followed up 3 months after last session. Results : The mean age of Vitiligo patients was 34.55±11.10, ranged from 20 to 60 years. Female gender (75%) was more affected than males (25%). Only 20% of Vitiligo patients had special habits. The median disease duration was 5.5 years ranged from 1 to 30 years Our results revealed that family history was positive in 65% of patients. The most affected sites were the trunk (30%) and the face (20%) followed by the LL (10%), the UL (10%) & hand (10%) but the least affected sites were the scalp, the breast, the neck and the foot 5% for each. Regarding the skin phototype 40% of all patients had skin type IV, 35% had skin type III while 25% had skin type II. The mean BMI (kg/m2) was 30.92±4.89 (23.88-42.22). After treatment on both sides (combined Fr: CO2 with PRP group and the PRP group), patients showed a highly statistically significant improvement in VAS score level as compared to before treatment levels. The group treated with combined Fr : CO2 with PRP showed higher significant size reduction when compared to PRP group. Laser and PRP treated site was significantly associated with higher proportion of inflammation (45% vs 15%,), non significantly higher proportion of pain (75% vs 60%) respectively when compared to PRP side while PRP showed non significantly higher proportion of burning (30% vs 20%) respectively when compared to other side. Excellent improvement showed higher frequency after Laser and PRP treatment, while lower grades (no, minimal, moderate) showed higher frequency after PRP treatment. Combined laser and PRP showed significantly better response on clinical grades. In PRP group Improvement differed significantly according to site of the lesion. Marked improvement was associated with face, neck and breast lesions. Moderate improvement was associated with trunk lesions. Minimal improvement was associated with UL, hand and scalp lesions. No improvement was associated with LL and foot lesions. Improvement after laser and PRP differed significantly according to the site of the lesion. Excellent improvement was associated with face, neck and breast lesions. Marked improvement was associated with trunk lesions. Moderate improvement was associated with UL and scalp lesions. Minimal improvement was associated with hand and LL lesions. No improvement was associated with foot lesion. DLQI decreased significantly after treatment. Conclusion : This study suggests that the combined Fr CO2 laser with PRP could be used effectively and safely to treat stable NSV. Combined Fr : CO2 with PRP group showed higher significant improvement when compared to PRP group. The group treated with combined Fr : CO2 with PRP showed higher significant size reduction when compared to PRP group.