Microneedling for Vitiligo

  • Best Results5 months
  • Treatment Recovery0-3 days
  • Procedure Time2-10 minutes
  • Skin SpecialistYou
  • Duration of ResultsVariable
  • AnaestheticIs possible
  • Back to Work0 days
  • Cost$

Microneedling for Vitiligo

Microneedling is a useful adjunctive treatment for stable areas of vitiligo. This is ideally performed in a clinic under medical supervision. The addition of 5FU, prostaglandin analogues, tacrolimus & other chemicals improve outcomes from needling. The gold standard for vitiligo treatment is phototherapy. Combination therapy works best.

FactsFacts on Microneedling for Vitiligo

  • Microneedling is a safe, effective & viable treatment for vitiligo
  • This treatment is best combined with prescription creams
  • Results can be seen as early as one month
  • 8-10 sessions are required, spaced 7-14 days apart
  • Adjunctive topicals include anti-inflammatories & pigment stimulating creams
  • Addition of phototherapy can speed up pigment formation

What is the logic behind microneedling for vitiligo?

This is a relatively new treatment. It works by –

  1. Facilitating drug delivery into the upper layers of skin.
  2. Release of growth factors to stimulate melanin production & hence pigmentation.
  3. Stimulation of germs cells in the hair follicle to differentiate into pigment cells.
  4. Migration of skin & pigment cells secondary to trauma.

What do the studies say?

Recent publications since 2020 have suggested that-

  1. Microneedling by itself has the potential to stimulate pigment production. A realistic goal is 20% improvement in 4 – 5 months.
  2. Microneedling combined with topicals including tacrolimus, 5FU & CS preparations have a higher rate of pigment production than without.
  3. Microneedling could be combined with phototherapy & topicals for faster regimentation.

How to microneedle?

Ideally, microneedling should be supervised by a dermatologist. In real life not everyone can see or afford a dermatologist. At Clinic Cutis this is how we perform microneedling:

  1. Baseline photos are taken to measure area of coverage of treated lesions. This is especially important to gauge the success/ failure of therapy.
  2. Prognosis is given based upon examination of vitiligo. This treatment is only suitable for stable lesions. Areas of poliosis (lack of pigment in hair follicles) carry a poor prognosis. Acral and distal lesions carry a poor prognosis.
  3. The area is numbed with lidocaine topically, then wiped with a chlorhexidine or iodine solution prior to microneedling.
  4. A stamper, roller or pen device is selected. I prefer rollers, my nurses prefer pens. I think stamping devices are safer for DIY tasks. Select 0.1 to 0.2 mm. The melanocytes are not deeper than this (unless one is targeting the follicular unit). For manual devices we perform 4-12 passes. The endpoint is redness & pinpoint bleeding. The areas are then cleaned.
  5. The topical of choice is placed on the microneedle areas. In the clinic I use 5FU, tacrolimus, CS infusions. For home use you can try pseudocatalase & Latiesse as these are easier to source.
  6. Repeat 10-14 days for 8-10 sessions. Retake photos & compare.

*Ideally microneedling should be combined with narrowband phototherapy.

** Safety is paramount, do not use needles longer than 0.2 mm at home.

How often should one microneedle?

Depending on the studies, once every 7 to 14 days. Do not exceed weekly microneedling as your skin needs time to heal. If you use a microneedle to 100 microns or 0.1 mm, it takes 21 to 28 days before the lowest point of injury turns over to the surface.

Davin’s Viewpoint on Microneedling for Vitiligo

Microneedling is a simple & cost-effective treatment. The application ranges from skin rejuvenation, scar correction, hair loss & even vitiligo. The results look promising. Needling itself can provide marginal improvements in stable patches of vitiligo. It is best used to provide increased drug delivery.

The current literature suggests that 5 fluorouracil is the topical solution of choice as this leads to the fastest re-pigmentation. More studies are required to confirm this.

I do employ microneedling as adjunctive therapy for vitiligo. Topicals, including prostaglandin E analogues, calcineurin inhibitors, & stronger corticosteroid solutions are the mainstay of treatment. These have the most amount of research behind them. I normally start all my patients on narrowband UVB at the same time.

It is not inconceivable that microneedling can be performed safely at home using 0.1 to 0.2 mm devices bought online. Sourcing topical drugs are the limiting factor, however pseudocatalase & Latiesse are readily available to purchase online.


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