Advanced Treatment of Vitiligo, a Study of Needling + UVB for Vitiligo

Objective: Vitiligo is an ever increasing problem in all age groups globally. Different regimens are in practice including sun exposure, UVR, Oral and Topical psoralens. Our study presents an original work with a new idea where NEEDLING is combined with narrow band UVB exposure. Our hypothesis is that the Melanocytes in the normal skin around the vitiligo patch can be pushed into the vitiligo patch and subsequent UVB induced melanogenesis treats vitiligo.

Methods: A 30-G needle with short stem is softly pushed through the normal skin edge in to the vitiligo patch at the level of the D-E junction parallel to the skin. This needle push called NEEDLING drags epidermal cells including melanocytes as micro inoculation to produce multiple small population of melanocytes in the vitiligo area, which is then exposed to narrow band UVB to cause melanogenesis and hence repigmentaiton of the area. Multiple needle pushes are made through the edge into vitiligo patch one centimeter apart. All patients are having needling once weekly and UVB 3 times a week.

A study of this combination was done over 300 patients, in both sexes in different age groups from July 2009 to July 2016 and follow up still continued. A comparison was also done with UVB alone (without needling) in some of these patients at some patches. Inclusion and exclusion criteria, a result criteria and a study Performa with follow-up details was set. Photos of all the patients were taken at the start and then every 3-weeks. Biopsy of few patients performed to observe the effects of needling.

Results: This combination treatment has proved very safe and effective against vitiligo as compared to UVB alone in all age groups. All patients had fast repigmentation. The best results are on the face with more then 90% repigmentation in all age groups. Repigmentation is still good but slower towards peripheral parts. Repigmentation was specially noticed to start from the edge of the vitiligo patch (where needling is started) as tiny balck dots and further needling through these dots gradually repigmented the central areas. Repigmentaion is also good over areas with grey hair with this technique as needling uses melanocytes of the skin surrounding the vitiligo patch rather then the follicular cells. This further strengthened the idea of needling as a useful combination with UVB.