الفهرس 
Evaluation of needling as an adjunct to phototherapy in the treatment of stable acral vitiligo : A comparative clinical and immunohistochemical
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Abstract
Background: Vitiligo is a tissue-specific, T cell-mediated, autoimmune cutaneous disorder wherein loss of functioning melanocytes from the basal layer of epidermis and/or hair follicles, leads to depigmented areas of the skin, mucous membranes, and/or hair.A myriad of therapeutic modalities is available for the treatment of vitiligo, but none has yet proven uniformly effective. Needling/microneedling can be exploited in vitiligo; primarily acting via therapeutic wounding with subsequent release of growth factors and cytokines. Aim of work: To evaluate the efficacy, safety, and tolerability of needling/microneedling as an adjunct to NB-UVB phototherapy in the treatment of localized stable refractory patches of acral vitiligo.Methodology:A total of 20 patients with stable acral vitiligo ({u2265}2 patches) were enrolled,wherein a total of 40 symmetrically distributed acral patches on both sides of the body were subjected to NB-UVB phototherapy, with or without needling/microneedling, as follows; in each individual patient, the whole body - including the two patches under study- was exposed to NB-UVB phototherapy. One of the two index patches was randomized to receive needling or microneedling adjuvant therapy in conjunction with NB-UVB. Phototherapy sessions were regularly carried out 3 times weekly, while needling sessions were carried out on biweekly basis for 6 consecutive months. Comparative assessment was carried out clinically, utilizing point counting method, VESTA, as well as the global patients{u2019} satisfaction scaled scoreandimmunohistochemically by quantitative assessment of melanocyte coun by Melan-A as well as qualitative assessment of p125FAK staining pattern.Adverse effects were monitored clinicallyand by inquisition. Result:No statistically significant difference was observed between NB-UVB monotherapy and either of the combined therapy regimens as regards the mean percentage change in vitiligo surface area estimated by point counting (p= 0.٤٥١)، mean change in absolute melanocyte count from baseline (p= 0.589), and mean VESTA (p=0.916). Side effects accompanying the adjuvant traumatizing modalities were barely tolerable, with no significant difference among both groups