Report of novel treatment of segmental vitiligo using combined microneedling and topical ruxolitinib

Abstract

Vitiligo is a chronic disease which manifests as patchy loss of skin pigmentation. It can be classified into two main types: segmental and nonsegmental. The condition can result in significant negative psychosocial effects, especially in skin of colour patients. These implications are particularly important in the social development of children and adolescents. As such, rapid‐acting, effective therapeutic options should be pursued when treating these patients. Topical ruxolitinib is the only approved drug for the treatment of vitiligo. Other procedural therapeutic options have also been explored including microneedling both alone and in conjunction with topical agents. Microneedling is thought to stimulate repigmentation through the induction of cytokines and growth factors which activate melanocytes and their precursors as well as through the creation of microchannels which allow for enhanced topical drug delivery. Its efficacy has been described in nonsegmental vitiligo cases, but its utility in segmental vitiligo has not been consistently characterised in the literature. We describe the first case of segmental vitiligo treated with combined microneedling and topical ruxolitinib in a skin of colour adolescent patient and review the purported mechanism of action of treatment.