Title : Microneedling along topical 5-fluorouracil in the treatment of stable resistant vitiligo
Abstract:
Introduction: Vitiligo, an acquired autoimmune depigmenting disorder of the skin. Vitiligo poses a challenge to all dermatologists with a major socio- psychological concern. The prevalence of vitiligo in Oman has been reported as 2.13% of the total Omani population attending Dermatology clinics in North Al Batinah Governorate over a period of 4 years between 2010-2013. Despite the available various numerous treatment modalities, a unique innovative universally reliable therapeutic modality is yet to emerge due to the disparity of response among different patients. Microneedling followed by the application of a topical 5% 5- fluorouracil (5-FU) is a novel and extremely understudied modality of treatment. Several reports have been surfacing regarding the efficacy of dermabrasion combined with 5-FU in the treatment of vitiligo.
Objective: The aim of this study is to assess the safety and efficacy of microneedling along with the application of topical 5-fluorouracil in the treatment of stable resistant vitiligo.
Methods: This study was intended to be a quasi, nonrandomized experimental design with the inclusion of 28 patients having localized stable vitiligo based on convenient sampling methods with certain inclusion criteria. Microneedling along with the application of topical 5-FU will be performed once every 2 weeks for a total duration of 6 months. The Epi-data software will be used for data collection, analysis and interpretation. Excellent results in terms of 50-75% repigmentation of the initial vitiligo macule/patch is expected with the 6 months period based on a previous recent study conducted within a similar scope. No major ethical concerns are associated with this study.
Discussion: Microneedling with a derma roller is becoming very popular in dermatology. Microneedling can increase the bioavailability of topical treatments and further enhances their transcutaneous absorption. In this study, we tried microneedling with a 540 needles dermaroller, 1.5 mm depth, as a simple, inexpensive, and quick procedure that can be used as a transdermal drug delivery modality. Hyperpigmentation, is a known side effect of 5-FU treatment that was observed during the treatment of skin tumors, and it was the basis of this study. Needling induces a strong trauma-induced inflammatory response inciting migration of keratinocyte along with melanocyte. The better therapeutic effect of microneedling with 5-FU can be explained by several mechanisms. Post microneedling, the 5-FU penetrates easily and deeply and stimulates the migration of active melanocytes from the pigmented to the achromic epidermis through enlarged intercellular spaces produced due to local edema. 5-FU also induces the overstimulation of follicular melanocytes, which migrate to the surface during epithelialization, resulting in hyperpigmentation. 5-FU competes with deoxyuridine and its derivatives for the enzyme thymidylate synthase and damages some inhibitory agents or cells within the epidermis or dermis that may be responsible for the destruction of pigment cells producing vitiligo.
Conclusion: We can say that microneedling with topical application of the 5-FU solution is a simple, cost-effective, and safe modality without the need of extensive surgical instruments and minimal side effects. It can be used as an alternative or additive method before, or in combination with other approved methods for stable vitiligo.
