PHOTOLYTIC-BASED HeNe LASER PHOTOPHORESIS OF COPPER PREPARATIONS IN THE TREATMENT OF VITILIGO: A PRELIMINARY REPORT

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Vitiligo, presenting as depigmented patches of skin surrounded by normal skin, is present in up to 2% of the population under the age of 40 and can present major problems as far as treatment is concerned, although diode laser therapy (LLLT) has had good results in the treatment of systemic vitiligo where melanocytes are present but are malfunctioning. The root cause of vitiligo remains uncertain, but possible etiologies are autoimmunological destruction or down-regulation of melanocytes, neural influences, hormonal influences, post-traumatic destruction of melanocytes, or a combination of these. Other than LLLT, oral psoralen plus ultraviolet A (PUVA) treatment has been used for resistant cases of vitiligo, but side effects from long-term UVA irradiation of the skin are now emerging. Corticosteroids have also been used but long-term corticosteroid application is also associated with undesirable side-effects. Copper has been recognized as an essential element in maintaining or restoring homeostasis of the organism. A new approach is presented, whereby a topical preparation containing copper is used in combination with helium-neon (HeNe) LLLT to induce photolytic-based photophoresis of the copper into the epidermal basal layer cells, including melanocytes. This technique is called copper laser photophoresis (CLPP). A 30-day controlled study was performed in 43 vitiligo patients, (ages 17-56 yr, 29 males and 14 females), comparing CLPP (n=20), PUVA (n=23). A further 14 unirradiated placebo controls with vitiligo (ages 12-60 yr) received only starch tablets and no form of phototherapy. After the 30 days 15 of the 15 CLPP subjects had complete repigmentation, compared with 5 of the PUVA group and none of the placebo group. No side effects were seen in the CLPP group, and no contraindications were noted. Burns occurred in 3 of the PUVA group. This was a preliminary trial with a small patient population, but the favourable results suggest that CLPP may well be a safe, easily administered, well-tolerated and effective treatment for vitiligo.