Fractional
carbon dioxide (
CO2) laser has been used with conventional treatments for
vitiligo, demonstrating more effectiveness compared with conventional treatments alone. Especially, fractional
CO2 laser combined with narrow-band ultraviolet B (NB-UVB) was shown to induce more improvement compared with NB-UVB monotherapy for treating stable non-segmental
vitiligo. However, the effectiveness of fractional
CO2 laser plus NB-UVB for the treatment of non-segmental
vitiligo remains controversial. Therefore, this study aimed to confirm the safety and efficacy of fractional
CO2 laser combined with NB-UVB compared with NB-UVB monotherapy in stable non-segmental
vitiligo. We searched the data from different databases, including Cochrane, Embase, and PubMed up to January 2020. Four randomized controlled trials (RCTs) for comparison between fractional
CO2 laser plus NB-UVB and NB-UVB monotherapy in patients with stable non-segmental
vitiligo were included. We performed meta-analyses for repigmentation improvement and patient satisfaction as well as subgroup analyses based on acral or non-acral
vitiligo, according to the
PRISMA guidelines. The combination treatment showed more superior results than NB-UVB monotherapy (≥ 75% repigmentation, RR 4.60, 95% CI 1.19-17.74; ≥ 50% repigmentation, RR 2.24, 95% CI 0.45-11.17; < 25% repigmentation, RR 0.81, 95% CI 0.60-1.08). Also, fractional
CO2 laser plus NB-UVB significantly improved acral and non-acral
vitiligo compared with NB-UVB monotherapy (standard mean difference (SMD) 1.24, 95% CI 0.66-1.82; SMD 1.14, 95% CI 0.67-1.60, respectively), while it increased markedly patient satisfaction compared with NB-UVB monotherapy (SMD 1.12, 95% CI 0.66-1.58). Collectively, this meta-analysis suggested that fractional
CO2 laser combined with NB-UVB might be more effective for treating non-segmental
vitiligo than NB-UVB monotherapy.