Clinical evaluation of the efficacy of trichloroacetic acid 70% after microneedling vs intradermal injection of 5‐fluorouracil in the treatment of nonsegmental vitiligo; A prospective comparative study

Abstract

Vitiligo is a skin disorder commonly acquired. Although different therapies are used, they are refractory to therapy in many cases. Trauma has been reported to cause hyperpigmentation by the pigment incontinence, which results in the build‐up of melanophages in the upper dermis after basal cell layer destruction. To detect the effectiveness of trichloroacetic acid (TCA) 70% in the treatment of nonsegmental vitiligo after skin microneedling by dermapen or intradermal injection of 5‐fluorouracil. Patients and methods A prospective comparative study was enrolled with 32 patients with vitiligo who were assigned to two equal groups. Each containing 16 patients; group 1 was treated by microneedling followed by TCA 70%, group 2 was treated by intradermal 5‐FU injection. This was done every 2 weeks for 2 months. Results According to the Physician's Global Assessment, there was no significant (P < .05) difference in the therapeutic response between the two studied groups. Conclusions Both microneedling plus TCA 70% and 5‐FU intradermal injection are a simple means of treating vitiligo with cosmetically accepted repigmentation of all age groups, as well as a relatively safe alternative or additive method that can be used before (or in combination with) any of the well‐known and widely approved method for stable nonsegmented vitiligo treatment.

Microneedling in vitiligo: A systematic review

“…The most common scale used to assess repigmentation was the 5‐grade repigmentation scale (or Physician's Global Assessment [PGA]) (G0‐G4; [11]): G4 (excellent: >75% repigmentation), G3 (very good: 50%‐75% repigmentation), G2 (good: 25%‐50%), G1 (satisfactory: <25% repigmentation), and G0 (poor: no repigmentation) 11,13‐18 . Visual analog scale was used in three studies 10,18‐20 . Other studies used investigator's global assessment (IGA) scoring and the measure of repigmentation diameter 21,22 …”

“…Those with 5-FU were: discomfort (n = 2), infection (n = 3). 18 Significantly greater pain level was noted in patients treated with laser-assisted dermabrasion compared to patients treated with.…”

“…11,[13][14][15][16][17][18] Visual analog scale was used in three studies. 10,[18][19][20] Other studies used investigator's global assessment (IGA) scoring and the measure of repigmentation diameter. 21,22…”

“…In the first group, TCA was applied immediately after patients underwent microneedling till an ivory white uniform frothing appeared. 18 In the second group, an injection of 0.01 to 0.02 mL 5-FU was applied intradermally in vitiligo areas at 1 cm intervals with a maximum of 250 mg per session. Both groups received treatment every 2 weeks for 2 months.…”

“…In both groups, 43.8% of patients had good-toexcellent improvement (repigmentation >50%). 18 3.1.10 | Hair transplantation and CO 2 laser or microneedling followed by nbUVB A pilot study compared the efficacy of hair transplantation and CO 2 laser or microneedling followed by nbUVB in the treatment of stable and refractory palmar-plantar vitiligo. 22 The authors compared two treatment approaches on symmetrical and comparable vitiligo lesions.…”