Comparative Clinical and Histological Study of Narrow Band UVB Phototherapy Versus Combined Narrow Band UVB Phototherapy and Microneedling in Treatment of Vitiligo

Abstract
Background: Vitiligo is an acquired pigmentary disorder of unknown etiology that affects up to 1% of the general population of all skin types.
It is a multifactorial disorder. There are numerous medical and surgical treatments aimed at repigmentation.
Microneedling is a minimally invasive procedure that uses fine needles to puncture the epidermis. The indications for microneedling therapy have grown significantly and it is becoming a widely used treatment in Dermatology.
Aim of Study: To study the clinical and histological efficacy of combined NB-UVB phototherapy and microneedling versus NB-UVB phototherapy in the treatment of vitiligo.
Patients and Methods: Twenty patients were divided into two Groups (A & B), each of 10 patients. Both groups were matched regarding age, sex, skin type and have a depigmented patch at the same corresponding site. Group A was subjected to microneedling with dermapen at one depigmented patch followed by NB-UVB phototherapy sessions twice weekly for three months. Group B was subjected to NB-UVB photo-therapy sessions twice weekly for three months. Two Skin biopsies one before and one after the therapy were taken for immunohistochemical examination by HMB 45.
Results: The mean percentage of improvement was sig-nificantly high in Group A (48.50%±26.46) than Group B (20.0%±19.58). In Group A 20% showed mild improvement (G1), 20% showed moderate improvement (G2), (40%) showed good improvement (G3) and 20% showed excellent improve-ment (G4). In Group B 30% showed no improvement, 50% showed mild improvement (G1), 10% showed moderate improvement (G2) and 10% showed good improvement (G3). There was statistically significant difference between both groups (p=0.027*).
Immunohistochemical changes revealed marked expression of HMB45 in Group A more than Group B, the mean of color intensity in Group A was 0.05±0.04 and a median of 0.03 while in Group B was 0.01±0.01. There was statistically significant difference between both groups (p=0.002*).
Conclusion: Microneedling prior to NB-UVB photother-apy sessions was clearly superior to NB-UVB phototherapy alone with accelerating response. Microneedling is a tolerable procedure, safe with minimal side effects.