Microneedling Combined With Topical 5-Fluorouracil More Effective Vitiligo Treatment Than Microneedling Alone

Combining microneedling with topical drug application yields better results than microneedling alone in treating localized vitiligo.

Microneedling combined with topical 5-fluorouracil (5-FU) outperformed microneedling alone in the treatment of vitiligo, according to the results of a study published in the Journal of Cosmetic Dermatology.

Patients with localized stable vitiligo were recruited from an outpatient dermatology clinic in Zagazig, Egypt. Eligible patients had not experienced any change in patch pigmentation or size in the 6 months prior to enrollment. Patients with more than 5 patches were excluded. In each patient, two patches <10 cm in diameter were chosen for treatment. Patch “A” was treated with microneedling alone; patch “B” was treated with microneedling followed by topical application of 5-FU. Treatments were repeated every 2 weeks for 3 months. Patches were photographed before and after treatment; a 5-grade scale was used to measure patch repigmentation. The scale ranged from “G0” to “G4”, designating “poor” to “excellent” repigmentation response, respectively. Side effects were also monitored throughout the trial.

The study cohort comprised 27 patients with vitiligo, of whom 15 (55.6%) were men. The mean (standard deviation [SD]) participant age was 26.7 (17.5) years. Disease duration ranged from 7 to 480 months, with a mean (SD) value of 75.4 (10.0) months. For patch A, none of the participants achieved G4 (“excellent”) or G3 (“very good”) grades of repigmentation. The majority (81.5%) experienced poor grade of repigmentation (G0). In patch B, however, 1 patient (3.7%) showed excellent grade of repigmentation (G4); 1 (3.7%) showed very good grade (G3); 3 (11.1%) showed good grade (G2); 14 (51.9%) showed satisfactory grade (G1); and just 8 (29.6%) showed poor grade (G0). Overall, treatment response was observed in 70.4% of patches treated with needling and 5-FU compared with 18.5% of patches treated with needling alone (P =.001). Side effects incidence was greater in patch B compared with patch A (P =.013). The most frequent side effects in both groups were pain and itching, which ended with treatment discontinuation. No serious adverse events occurred during the trial.

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Compared with microneedling alone, microneedling combined with topical 5-FU yielded better repigmentation response in vitiligo patches. Although side effects were more common with the combined treatment method, none were serious. The strength of these conclusions is limited by small sample size and short study duration, and replication in a larger cohort is necessary to confirm the efficacy and safety of the combined treatment method. Microneedling with 5-FU was a viable treatment for localized stable vitiligo, investigators wrote, “with the advantages of low cost, good efficacy, well‐tolerability, and less side effects.”

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Attwa EM, Khashaba SA, Ezzat NA. Evaluation of the additional effect of topical 5‐fluorouracil to needling in the treatment of localized vitiligo [published online September 16, 2019]. J Cosmet Dermatol. doi:10.1111/jocd.13152