Management of acral vitiligo using Narrow band UVB, microneedling with and without platelet rich plasma

Abstract Background: Acral vitiligo is usually more resistant to medical management due to minimal density of hair follicles and greater chance of repeated friction or trauma. Objective: To determine efficacy and safety of adding topical platelet rich plasma (PRP) to automated micro needling and narrow band ultra violet B (NB- UVB) in treatment of resistant acral vitiligo and to assess the best treated sites with this combination therapy. Patients and methods: Forty-two patients with stable acral vitiligo were recruited. lesions at the hand were classified according to their sites into (Dorsum, periungual, knuckles and inversed knuckles)while lesions at the feet were classified into (Dorsum, lateral side and medial side of the feet). One side was treated with automated micro needling and topical PRP (group A) and the other side with automated micro needling only (group B) twice monthly for 3 months. Both sides received NB-UVB phototherapy twice weekly. Results: One month after the last session, in both groups A and B, a statistically significant better percent of pigmentation was noticed at the dorsum of the hands 38.95 ± 39.81 and 42.11 ± 33.51 respectively followed by inverted knuckles 28.42 ± 37.01 and 25.53 ± 37.19 respectively , while no significant difference was noted in comparing both groups A and B either at the hands or the feet lesions, regarding the percent of regimentation, the percent of change in VASI, change in number of the lesions and color match. Conclusion: Adding PRP to NB-UVB and micro needling has no significant advantage in treating patients with resistant acral vitiligo. The response to treatment is better in area with hair follicles as the dorsum of the hand and inverted knuckles, while areas over bony prominences (knuckles) and devoid of hair follicles (periungual) are resistant to this combination therapy.