What are safe ways to treat acne scars for vitiligo?

Safe treatments for acne scars in patients with vitiligo include non-laser modalities such as microneedling, biofiller (autologous platelet-poor plasma gel), and topical therapies. These options are generally considered safer because they carry a lower risk of inducing or worsening depigmentation compared to many laser treatments.

Key safe options:

Microneedling: This technique uses fine needles to create micro-injuries, stimulating collagen without significant risk of pigmentary alteration. Microneedling has been shown to be safe and effective for both acne scars and, when combined with topical agents, for vitiligo lesions.

Biofiller (PPP gel): Autologous platelet-poor plasma gel injections are minimally invasive, cost-effective, and have no risk of immunogenic reaction or pigmentary change, making them suitable for patients with vitiligo.

Topical therapies: While not directly treating scars, topical corticosteroids or calcineurin inhibitors are first-line for vitiligo and can be safely combined with microneedling for repigmentation.

Laser treatments (including fractional CO₂ and Er:YAG lasers) are effective for acne scars in the general population, but they carry a risk of post-inflammatory pigmentary changes, including both hyperpigmentation and hypopigmentation. In patients with vitiligo, there is a theoretical and reported risk that laser treatments may trigger new vitiligo lesions (Koebner phenomenon) or worsen depigmentation. Therefore, ablative and non-ablative lasers should be used with extreme caution or avoided in vitiligo patients unless the benefit clearly outweighs the risk and the patient is fully informed.

V-beam (Pulsed Dye Laser, PDL) safety in vitiligo:

The V-beam laser targets vascular lesions and is generally considered less likely to induce pigmentary changes than ablative lasers. However, there are case reports and theoretical concerns that even PDL can rarely trigger the Koebner phenomenon in vitiligo, leading to new depigmented patches. The safety profile is better than with ablative lasers, but it is not entirely risk-free for vitiligo patients. Use should be cautious, and patients should be counseled about the potential risk of inducing new vitiligo lesions.

In summary, microneedling and biofiller are the safest and most effective options for treating acne scars in patients with vitiligo. V-beam (PDL) is relatively safer than ablative lasers but still carries some risk of inducing vitiligo lesions and should be used with caution. Avoid ablative and non-ablative lasers unless absolutely necessary and after thorough patient counseling.