Excimer 308 nm for Focal Vitiligo (Face/Neck): Protocols, Response Kinetics, and Combinations

Key Takeaways

Targeted therapy ideal for focal lesions, active edges, and facial/neck sites; enables high local dose while sparing uninvolved skin.
Typical regimens: 2–3×/week; islands visible by weeks 4–8 on face/neck; acral margins respond slower and need longer courses.
Combinations with tacrolimus 0.1% or pimecrolimus 1% speed and deepen repigmentation; useful after stabilization.
Safety: dose-escalate to minimal persistent erythema; avoid burns/blistering; eye protection mandatory.

Limited patches (<10% BSA), facial/periorificial lesions, or refractory rims during NB-UVB.
Acral margins and segmental edges where precision dosing is advantageous.
Post-stabilization intensification following mini-pulse steroids in rapidly progressive disease.

Table 1. Common 308 nm dosing frameworks.

Parameter	Typical	Notes
Frequency	2–3 sessions/week	Minimum 16–24 sessions initial
Start dose	200–300 mJ/cm² (face) \| 250–400 mJ/cm² (body)	Adjust by phototype/site
Increment	10–20% per visit if no >24 h erythema	Hold/reduce after persistent erythema
Endpoint	Visible perifollicular islands, border contraction	Then taper frequency

Table 2. Typical response gradient.

Site	Response	Notes
Face/neck	High	Fast islands (4–8 wks)
Trunk/limbs (non-acral)	Moderate	12–24 wks consolidation
Acral (hands/feet)	Low–moderate	Prolonged course; consider topicals/surgery

Tacrolimus 0.1% on off-days (face/neck) to reduce relapse and deepen fill-in.
Pimecrolimus 1% as steroid-sparing alternative for sensitive zones.
NB-UVB 311 nm as background for generalized disease; use 308 nm to “finish” edges.
Topical JAK for persistent facial lesions within label BSA limits.

Table 3. Common issues and management.

Issue	Pattern	Action
Erythema >24 h	Dose too high	Hold until clear; reduce 10–20%
Blistering (rare)	Over-escalation	Stop; wound care; restart low
Slow response (acral)	Minimal islands	Add calcineurin/JAK; extend sessions
Relapse after stop	Edge reactivation	Maintenance topicals; intermittent boosts

Table 4. Populate with study numerics.

Outcome	Excimer 308	Comparator	Interpretation
F-VASI % change (12–24 wks)	—	Topicals alone	Favors excimer on face
Time to first islands (wks)	4–8	—	Fastest on face/neck
Acral responder rate	—	—	Lower; needs combination
AE rate (erythema/burn)	—	—	Low with careful titration

Clinical cohorts and split-lesion studies of 308 nm excimer in facial and focal vitiligo.
Comparative/adjunct studies with NB-UVB and calcineurin inhibitors.
Guidelines on targeted phototherapy dosing and safety.