Vitiligo is a chronic autoimmune dermatological disorder characterized by the selective destruction of melanocytes, resulting in depigmented macules and patches on the skin and mucous membranes. The pathogenesis involves a complex interplay of genetic susceptibility, environmental triggers, oxidative stress, and immune-mediated mechanisms, including T-cell infiltration and cytokine dysregulation, particularly involving the JAK-STAT pathway.This leads to progressive loss of pigmentation, often with a significant psychosocial impact due to aesthetic concerns and associated stigma.

Vitiligo is classified into several types based on clinical presentation. Non-segmental vitiligo (NSV), the most common form, is bilateral and symmetrical, encompassing subtypes such as generalized, acrofacial, and universal vitiligo. Segmental vitiligo, in contrast, is unilateral and follows a dermatomal distribution, often stabilizing early. Other variants include focal and mucosal types, with the disease categorized by activity as stable (no progression for at least one year) or active/progressive.

Epidemiologically, vitiligo affects approximately 0.5-1% of the global population, with prevalence varying regionally. A 2024 meta-analysis estimated a pooled prevalence of 0.5% among adults, with higher rates in South Asia, including India, where genetic and environmental factors may contribute to a prevalence of up to 2-3%. Incidence rates range from 0.2-0.4 per 1,000 person-years, with onset typically between 10-30 years.

Current treatment options aim to stabilize disease progression and promote repigmentation. Medical therapies include topical corticosteroids, calcineurin inhibitors (e.g., tacrolimus 0.1%), and JAK inhibitors (e.g., ruxolitinib 1.5% cream), with the latter showing efficacy in NSV through phase III trials. Phototherapies like narrowband UVB (NB-UVB) and excimer laser (308 nm) are effective for widespread cases, achieving 50-75% repigmentation. Surgical options, such as autologous grafting, are reserved for stable vitiligo, yielding over 70% repigmentation.

Due to variable response to monotherapy, combination therapies are increasingly utilized. Common regimens include NB-UVB with tacrolimus or ruxolitinib, enhancing repigmentation through synergistic effects.^[9][6] Fractional CO2 laser-assisted drug delivery (LADD) with phototherapy improves topical penetration, showing promise in resistant cases.

This study investigates the comparative efficacy of CO2 laser-assisted delivery of tacrolimus versus ruxolitinib, both combined with excimer laser, to optimize treatment for recalcitrant vitiligo in a diverse population.