Title : Advance treatment of vitiligo with needling+excimer laser
Introduction: Vitiligo is an ever increasing problem in all age groups. Different regimens in practice are sun exposure, UVR and psoralens. My paper presents an original study where NEEDLING is combined with EXCIMER LASER @308nm.
Our hypothesis is that epidermal cells in the skin around the vitiligo patch can be pushed from normal skin into the vitiligo patch and subsequent exposure to EXCIMER laser induced melaneogenesis treats vitiligo.
Methods: A 31 G needle is softly pushed through the normal skin in to the vitiligo patch at level of dermo-epidermal junction parallel to skin. "This needle push called NEEDLING" pushes epidermal cells including melanocytes into the vitiligo patch as micro inoculation to produce multiple small populations of melanocytes, which is then exposed to increasing doses of EXCIMER laser to cause melanogenesis and hence repigmentation of the area.
Multiple needle pushes are made through the edge 2 centimeter apart. AII patients having needling once weekly and EXCIMER 2 times a week.
This study was done over 40 patients in both sexes in different age groups from march 2020 to-date and follow up continud todate. A comparison was also done with EXCIMER alone. Photos of all patients taken at the start and then every 3 weeks.Biopsy of few patients performed to observe the effects of needling.
Results: This combination treatment has proved very safe and effective against vitiligo as compared to EXCIMER alone.
AII patients had fast repigmentation.The best results are on face with more then 90% repigmentation. Repigmentation is good but slower towards peripheral parts.Repigmentation specially noted to start from edge of vitiligo patch (where needling is done) as tiny black dots and further needling through these dots gradually repigmented the central areas.Repigmentation is also good over areas with grey hair with this technique as needling uses melanocytes of the surrounding skin rather then the follicular cells. This further strengthened the idea of needling.