Background: Vitiligo is an acquired depigmentary disorder of multifactorial etiology. Several treatment modalities have been attempted with partial success, but the recent focus on surgical treatment like micro-needling. Objective: To compare the safety and ability of micro-needling alone in the induction of pigmentation in stable vitiligo versus combined tacrolimus treatment and micro-needling. Patients and methods: Twenty three patients with stable vitiligo were recruited from the Department of Dermatology and Venereology of Salah Aldeen General Hospital. The patients then subjected to micro-needling of the two vitiliginous patches after that application of topical tacrolimus to the left patch. This procedure was repeated every two weeks for a maximum of 5 months ( 10 sessions). Results: Microneedling with topical tacrolimus showed better but non-significant response than micro-needling alone ( p = 0.519). Moderate improvement occurred in 13% of patches treated with micro-needling alone, while only 9% show moderate improvement in combined treatment. Although 9% show good improvement in combined treatment. Conclusion: Micro-needling induces pigmentation in vitiligo patients, and the addition of topical tacrolimus induces a better response.However, no statistically significant response was observed in any group.

Sir, Urticaria is an immunologically mediated hypersensitivity reaction developing in both sexes. Although it may occur at any age, young females are more frequently affected [1]. Acute urticaria, shorter than six weeks, is generally self-limited. In contrast, a patient with urticaria lasting more than six weeks is classified as having chronic urticaria. Patients with chronic urticaria may be classified into either chronic inducible urticaria or chronic spontaneous urticaria (CSU). Urticaria may be either a true IgE mediated allergic reaction or a non-IgE mediated pseudo-allergic reaction by releasing prostaglandins and leukotrienes [2]. A routine test usually includes CBC, ESR, and infection screening. Provocation tests for physical urticaria and immunological tests are performed to identify autoimmune urticaria. Skin prick tests and oral provocation tests are employed to differentiate allergic and pseudo-allergic reactions [3]. In contrast to physical urticaria, in which the triggering physical stimuli is usually easy to identify, it is often cumbersome to determine the trigger of chronic spontaneous urticaria. The following case represents an example of such a hidden trigger of CSU.