The addition of microneedling with triamcinolone acetonide to narrowband ultraviolet B (NB-UVB) phototherapy is a reasonable, well-tolerated combination treatment for patients with resistant vitiligo, according to the results of a recent randomized, comparative study published in the Journal of the American Academy of Dermatology.

The investigators sought to compare the efficacy of needling with a topical steroid (triamcinolone acetonide) alone or in combination with NB-UVB vs the use of NB-UVB alone as a standard therapeutic modality in patients with vitiligo. A total of 60 patients with acrofacial vitiligo were randomly assigned to 1 of 3 treatment groups: group 1, NB-UVB therapy (n=20); group 2, needling once weekly for 3 months, followed by topical application of triamcinolone acetonide (n=20); or group 3, a combination of both treatment modalities (n=20).

Overall, 45% of participants were male and 55% were female. Patients’ age range was 13 to 50 years; median duration of vitiligo was from 5 to 60 months. Family history of vitiligo was low among all 3 groups.


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No statistically significant difference in grade of repigmentation was observed among the 3 groups, with the best outcome reported in group 3 (40% of participants with a good response and 30% with an excellent response). In contrast, in group 1, 20% of participants reported a good response and no participants reported an excellent response, and in group 2, 30% of participants had a good response and 15% had an excellent response.

A statistically significant difference was observed among the treatment groups with respect to patient satisfaction, with 40% of those in group 3 reporting excellent satisfaction compared with 25% in group 2 and 0% in group 1 (P =.024).

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The use of microneedling was associated with a good to excellent response in 45% of participants, and the combination of needling plus NB-UVB increased that percentage to 70%. The incidence of adverse effects among the treatment groups was minimal, except for pain, which was controlled with the use of a topical anesthetic before a treatment session.

The researchers concluded that the combination of needling and NB-UVB in patients with vitiligo is a safe and effective treatment modality.

Reference

Khashaba S, Elkot RA, Ibrahim SHM. Efficacy of NBUVB, microneedling with triamiconolone acetonide and combination of both modalities in treatment of vitiligo: a comparative study [published online December 29, 2017]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2017.12.054