Efficacy and Safety of 308 nm Excimer Light Combined With Compound Tretinoin Clobetasol Propionate Cream for Stable Acral Vitiligo: A Randomized, Double‐Blind, and Self‐Controlled Pilot Study

Acral vitiligo is a kind of recalcitrant non‐segmental vitiligo. Although tretinoin has been applied to vitiligo [1], clinical reports remain limited. This study aimed to evaluate the efficacy and safety of combining 308 nm excimer light with compound tretinoin clobetasol propionate cream for treating stable acral vitiligo.

We conducted the prospective, double‐blind (investigator & participant, conducted by Yan Sun) and self‐controlled pilot study at the Dermatology Department of the First Hospital of China Medical University between September 2021 and July 2024. Eligible participants were aged between 18 and 55 years. Each patient was diagnosis as stable acral vitiligo (stable for more than a year) and had at least one patch on each hand and total involved body surface area (BSA) of < 5%. One target patch on each side was randomly (random number table by Yan Sun) assigned to the treatment side or the control side. All patches underwent 308 nm excimer light (Therabeam UV 308; Ushio Inc., Tokyo, Japan) irradiation treatment twice weekly. The minimal erythema dose (MED) of each patient was tested before irradiation. The initial dose was determined by MED, ranging from 200 mJ/cm² to 2100 mJ/cm². The subsequent radiation dose was adjusted based on the response to previous treatment. In addition, the treatment side received nightly application of compound tretinoin clobetasol propionate cream (0.025% tretinoin and 0.05% clobetasol propionate) (Jiangsu Zhiyuan Pharmaceutical Co. Ltd. China) on non‐irradiation days, while the control side received 0.05% clobetasol propionate cream (Guangdong Huarun Shunfeng Pharmaceutical Co. Ltd. China) alone. The treatment course lasted 24 weeks. Improvement was assessed based on re‐pigmentation rate. Patient‐reported outcomes were measured using the Dermatology Life Quality Index (DLQI) questionnaire consisting of 10 questions with six domains (symptoms and feeling, daily activities, leisure, work and school, personal relationships, and treatment difficulties). The data were statistically analyzed by SPSS version 26.0 (Windows, IBM). The comparison between the two sides were conducted by Wilcoxon signed rank test and Mann–Whitney U test. p < 0.05 was considered as statistical significance.

Thirty patients with 60 vitiligo patches (located on the hands) completed the trial. The mean age was 36.47 ± 8.70 years, with a duration of vitiligo ranging from 1 to 20 years (5.83 ± 5.95 years). Five patients (16.6%) reported a family history of vitiligo. There weren't any statistically significant differences in the cumulative 308 nm excimer light dose over the observation period between the two sides (Month 3: 10.52 ± 0.50 vs. 10.57 ± 0.55 J, Month 6: 27.10 ± 1.95 vs. 27.10 ± 1.71 J; p > 0.05). After the 3‐month‐treatment, the re‐pigmentation rate was significantly higher on the treatment side (13.77% ± 17.34%) than on the control side (7.67% ± 11.28%; p = 0.001). Similar results were observed after 6‐months of treatment (38.67% ± 36.43% vs. 27.00% ± 30.95%; p = 0.001). Global DLQI scores decreased after treatment, from 9.67 ± 6.16 at baseline to 9.13 ± 5.98 after 3 months (p = 0.001) and to 6.97 ± 4.95 after 6 months of treatment (p = 0.000). All patients reported erythema on both sides. Other side effects, including pruritus, desquamation, pain, dryness, were mild and resolved with topical emollients in a few days (Figure 1).

FIGURE 1.

Clinical photographs of a representative patient before and after treatment.

Combination therapies often yield better outcomes, although patient satisfaction in acral vitiligo remains variable [2]. The use of 308 nm excimer light has gained increasing advocacy for various dermatoses in recent years. Topical corticosteroids are a first‐line therapy for vitiligo but are associated with some side effects, such as hyperpigmentation [3] and skin thinning [4]. In contrast, 0.05% tretinoin cream can prevent hyperpigmentation during narrowband ultraviolet B (NB‐UVB) phototherapy in facial vitiligo, without compromising the outcomes [5]. In our study, 308 nm excimer light combined with compound tretinoin clobetasol propionate was an effective treatment for stable acral vitiligo, which might offer a valuable new therapeutic option.

Funding

This work was supported in part by the National Key R&D Program of China (2023YFC2508200).

Disclosure

Publication statement: We guarantee that the data in our manuscript is original and the manuscript is not under consideration elsewhere. None of the manuscript contents have been previously published.

Ethics Statement

All patients signed the informed consent form before enrollment. The authors attest to obtaining written patient consent for the publication of recognizable patient photographs or other identifiable material, with the understanding that this information may be publicly available. The study protocol was approved by the Medical Ethics and Human Research Committee of China Medical University (No. [2021] 213).

Conflicts of Interest

The authors declare no conflicts of interest.

Hageb O. A., Sun Y., and Gao X.‐H., “Efficacy and Safety of 308 nm Excimer Light Combined With Compound Tretinoin Clobetasol Propionate Cream for Stable Acral Vitiligo: A Randomized, Double‐Blind, and Self‐Controlled Pilot Study,” International Journal of Dermatology 65, no. 10 (2026): 2169–2171, 10.1111/ijd.70427.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.