Abstract: 【Abstract】 Objective To compare the efficacy of fractional CO2 laser combined with topical delivery of fluorouracil versus compound betamethasone injections in the treatment of vitiligo. Methods Clinical data were collected from 94 patients with localized, non-segmental, and stable vitiligo, who received fractional CO2 laser combined with drug delivery at the Cosmetological Center, Xijing Hospital, Air Force Medical University from October 2018 to May 2023, and were retrospectively analyzed. Among them, there were 40 cases in the fractional CO2 laser combined with fluorouracil injection group, and 54 cases in the fractional CO2 laser combined with compound betamethasone injection group. All the patients received the above treatment once a month for 5 sessions. A 4-level grading scale was used to evaluate the pigmentation improvement, and the clinical efficacy and safety of the two therapeutic regimens were compared. Comparisons between groups were performed using chi-square test, Fisher′s exact test, and t test. Results In the fractional CO2 laser combined with fluorouracil injection group, there were 22 males and 18 females, their ages were 21.95 ± 12.88 years, and the disease duration was 25.46 ± 11.42 months; in the fractional CO2 laser combined with compound betamethasone injection group, there were 36 males and 18 females, their ages were 22.26 ± 8.79 years, and the disease duration was 26.51 ± 12.81 months. One month after the first treatment, no significant difference was observed in the efficacy between the two groups （χ2 = 1.39, P = 0.238）. One month after the fifth treatment, 2 （5.0%） patients showed an excellent response, 4 （10.0%） showed a good response, 12 （30.0%） showed a mild response, and 22 （55.0%） showed a poor response in the fractional CO2 laser combined with fluorouracil injection group; in the fractional CO2 laser combined with compound betamethasone injection group, 8 （14.8%） patients showed a good response, 8 （14.8%） showed a mild response, and 38 （70.4%） showed a poor response; there was no significant difference in the efficacy between the two groups after 5 sessions of treatment （χ2 = 2.35, P = 0.125）. After either 1 or 5 sessions of treatment, there were no significant differences in the efficacy for lesions on the face and neck, trunk and limbs, hands and feet between the two therapeutic regimens （all P > 0.05）. Comparisons of the efficacy for skin lesions on different body sites showed that one session of the fractional CO2 laser combined with fluorouracil injection was more effective for the treatment of skin lesions on the face and neck compared with those on the hands and feet （P = 0.039）; after 5 sessions of treatment, the two therapeutic regimens both showed better efficacy for facial skin lesions compared with hand and foot skin lesions （P = 0.005, 0.049）. There was no significant difference in the occurrence of adverse reactions such as pigmentation, infection and scarring between the two groups. Conclusion The fractional CO2 laser combined with topical delivery of fluorouracil and compound betamethasone injections showed similar efficacy and safety in the treatment of vitiligo, and both can be used as treatment options for vitiligo.

Key words: Vitiligo, Laser therapy, Fluorouracil, Treatment outcome, Fractional CO2 laser, Compound betamethasone injection