Key Takeaways
- Excimer 308 nm is well suited for localized/focal lesions, particularly on the face and neck, enabling targeted high-fluence delivery with tissue sparing.
- Typical schedules are 2–3 sessions/week with dose escalation to minimal symptomatic erythema; early perifollicular islands predict better outcomes.
- Safety profile is favorable when respecting dose thresholds; common effects are transient erythema and dryness.
- Combination with topical calcineurin inhibitors or targeted steroids can accelerate repigmentation in selected patients.
Abstract
This article reviews the role of excimer 308 nm laser in focal vitiligo with emphasis on cosmetically sensitive areas (face/neck). We summarize patient selection, practical dosing parameters, expected efficacy patterns, safety considerations, and common combination regimens.
Indications & Patient Selection
- Focal or limited nonsegmental lesions, especially in face/neck zones.
- Stable segmental patches amenable to targeted therapy.
- Patients preferring localized treatment or those unsuitable for booth-based phototherapy.
- Avoid in widespread disease where whole-body NB-UVB is more efficient.
Dosing Parameters
| Parameter | Typical setting | Notes |
|---|---|---|
| Frequency | 2–3×/week | Avoid consecutive days on sensitive areas |
| Starting dose | ~150–250 mJ/cm² | Lower for face/intertriginous areas |
| Escalation | +10–20%/session | Target mild, short-lived erythema only |
| Max dose | ~800–1,000 mJ/cm² | Clinic protocols vary; respect tolerance |
| Course length | 12–24 weeks | Evaluate early perifollicular response at 4–8 weeks |
Efficacy on Face/Neck
Face and neck typically show the highest cosmetic gain due to follicular reservoir and better light access. Early perifollicular islands and margin softening herald broader repigmentation. Acral sites (fingers, toes) remain challenging and may require adjuncts.
| Readout | Description | When to assess |
|---|---|---|
| F-VASI change | Facial area index for standardized tracking | Baseline, week 8, 12, 24 |
| Perifollicular islands | Early islands predict end-response | Weeks 4–8 |
| Photographic global assessment | Blinded paired photo review | Every 4–8 weeks |
| Durability | Persistence after stop ± maintenance | 3–6 months post-course |
Safety
| Event | Typical course | Management |
|---|---|---|
| Erythema | Transient | Hold/reduce next dose; emollients |
| Dryness/itch | Mild | Emollients; short course low-potency steroid if needed |
| Blistering (overdose) | Rare | Pause therapy; wound care; step-down on restart |
Combination Strategies
- Topical calcineurin inhibitors (tacrolimus/pimecrolimus) on face/neck to enhance and maintain gains.
- Short, intermittent topical steroid pulses for non-facial sites with caution.
- Transition to NB-UVB for more extensive spread or maintenance when focal disease widens.
Limitations
Evidence base is heterogeneous; lesion selection and dose discipline are critical. Acral and long-standing leukotrichia respond poorly. Cost and access vary by region.
References
- Clinical series and comparative reports on excimer 308 nm for localized vitiligo, with emphasis on facial outcomes.
- Guidance documents on targeted phototherapy dosing and safety monitoring in vitiligo.
- Reviews on combination strategies with calcineurin inhibitors for facial lesions.