The microscopic thermal zones (MTZs) produced by fractional CO2 lasers act as a physical and biological bridge across the lesion's edge. By deliberately overlapping the laser treatment onto the surrounding normal skin, these zones induce a "seeding-like" migration of pigment cells. This process triggers tissue contraction and repair signals that encourage active melanocytes to travel from the healthy border into the depigmented lesion.
The core function of these thermal zones at the lesion edge is to mobilize a "reservoir" of healthy pigment cells, providing them with the physical pathways and biochemical signals necessary to repigment the white patches.
The Mechanism of Edge-Based Repigmentation
The "Seeding" Effect
The primary reference indicates that the laser treatment must cover not just the vitiligo lesion, but also a margin of surrounding normal skin.
This overlap is critical. It utilizes the healthy skin as a reservoir of active melanocytes. The MTZs facilitate a migration process where these pigment-producing cells are effectively "seeded" from the healthy edge into the depigmented area.
Creating Physical Pathways
The laser creates specific micro-channels—physical gaps in the tissue—through a process of non-continuous ablation.
These channels serve as a roadmap for cellular movement. By breaking down the local tissue structure, the laser establishes a clear physical path for melanocytes to traverse from the edge into the center of the lesion.
Triggering Biochemical Repair Signals
Beyond physical channels, the thermal energy creates a specific biochemical microenvironment.
The heat from the MTZs causes immediate tissue contraction and stimulates a wound-healing response. This releases specific growth factors and cytokines (such as melanocyte mitogens) that biologically signal the melanocytes at the edge to proliferate and move.
Understanding the Trade-offs
Controlled Trauma is Required
To trigger this migration, the skin must undergo controlled thermal damage.
The process relies on creating "micro-thermal injury zones." While this stimulates healing, it creates a temporary wound that requires the surrounding tissue to remain intact to function as a repair source.
The Necessity of the "Reservoir"
The effectiveness of treating the edges relies entirely on the health of the surrounding skin.
Because the process depends on migration rather than spontaneous generation of pigment, the technique is less effective if the "reservoir" of healthy skin at the margins is depleted or inactive.
Optimizing Treatment for Repigmentation
If your primary focus is stimulating natural pigmentation:
- Ensure the laser treatment parameters allow for sufficient overlap with the healthy skin margin to activate the melanocyte reservoir.
If your primary focus is enhancing combination therapies:
- Utilize the micro-channels created at the edges to improve the absorption depth of topical treatments or PRP, as the barrier function is temporarily modified.
Success in fractional CO2 treatment lies in viewing the lesion edge not as a boundary, but as the active source of repigmentation.
Summary Table:
| Mechanism Component | Action at Vitiligo Edge | Biological Result |
|---|---|---|
| Seeding Effect | Overlap treatment onto healthy skin | Mobilizes melanocyte reservoir |
| Micro-Channels | Non-continuous tissue ablation | Creates physical pathways for cell migration |
| Thermal Energy | Immediate tissue contraction | Triggers repair signals and growth factors |
| Wound Healing | Controlled micro-thermal injury | Stimulates melanocyte proliferation |
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References
- Jinping Yuan, Hong‐Duo Chen. Fractional CO2 lasers contribute to the treatment of stable non-segmental vitiligo. DOI: 10.1684/ejd.2016.2875
This article is also based on technical information from Belislaser Knowledge Base .
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