Assessment of Efficacy and Patient Satisfaction with Fractional CO₂ Laser in Vitiligo Treatment

Abstract

Background: Vitiligo is a common acquired depigmenting disorder with substantial psychosocial consequences. Conventional treatments, topical immunomodulators, phototherapy, and surgical techniques often yield partial or slow repigmentation, and relapse remains frequent. Objective: To assess the therapeutic efficacy of fractional carbon dioxide laser for vitiligo and to evaluate patient satisfaction. Method: A single-arm interventional study was conducted in a private dermatology clinic in Iraq, from February 2024 to February 2025, enrolling consecutive adults with stable, non-segmental vitiligo of Fitzpatrick skin phototypes III–IV. Treatment consisted of fractional ablative carbon dioxide laser sessions scheduled every two to three weeks. Outcomes were evaluated at three and six months from the first session. Results: Participants completed a median of six fractional CO₂ laser sessions (range 4–7). At three months, 50.0% achieved an excellent response, 26.7% a moderate response, and 23.3% a poor response. The mean patient-reported satisfaction score at three months was 3.6±1.0. By six months, 60.0% remained relapse-free. Compared with relapsers, non-relapsers were more often male (72.2% vs. 41.7%; p=0.018), had shorter disease duration (3.0±2.2 vs. 4.8±3.4 years; p=0.026), and reported higher satisfaction (4.0±0.6 vs. 2.9±1.1; p<0.001). The lesion site was highly correlated with outcomes (overall p<0.001). Conclusions: The fractional carbon dioxide laser resulted in statistically meaningful repigmentation and was tolerated reasonably well, with favorable patient-reported satisfaction. Our findings supported site-specific counseling and treatment duration, as site-specific results differed by lesion and duration of disease.