- Best Results5 months
- Treatment Recovery0-3 days
- Procedure Time2-10 minutes
- Skin SpecialistYou
- Duration of ResultsVariable
- AnaestheticIs possible
- Back to Work0 days
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 –
- Facilitating drug delivery into the upper layers of skin.
- Release of growth factors to stimulate melanin production & hence pigmentation.
- Stimulation of germs cells in the hair follicle to differentiate into pigment cells.
- Migration of skin & pigment cells secondary to trauma.
What do the studies say?
Recent publications since 2020 have suggested that-
- Microneedling by itself has the potential to stimulate pigment production. A realistic goal is 20% improvement in 4 – 5 months.
- Microneedling combined with topicals including tacrolimus, 5FU & CS preparations have a higher rate of pigment production than without.
- 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:
- Baseline photos are taken to measure area of coverage of treated lesions. This is especially important to gauge the success/ failure of therapy.
- 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.
- The area is numbed with lidocaine topically, then wiped with a chlorhexidine or iodine solution prior to microneedling.
- 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.
- 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.
- 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.
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How long does it take to notice results from microneedling?
It really depends on the addition of other adjunctive treatments. The fastest re-pigmentation according to clinical papers is with the addition of chemotherapy, namely 5FU. Results are seen as early as one month.
A more realistic outcome is 15 to 30% improvement after 4 months (conducted twice a month for 8 sessions in total). Adding medical grade phototherapy & topicals can accelerate this process.
As with all vitiligo therapies, facial involvement responds better than vitiligo of the hands & feet (acral vitiligo).
How can hair be different on Accutane- what to look for?
1-3 days, even if it is done by my team. This is because we don’t exceed 0.2 mm (the same length as DIY microneedling). There is no requirement to go deeper. I am treating melanocytes that live at 100-150 microns, not scarring that is 3000 microns deep.
Post microneedling you will be a wee bit red. This usually dissipates within 12 hours. You can resume your normal activities the next day, including make up application if required.
Is this procedure painful?
No. If my clinical team performs microneedling we use topical anaesthetic beforehand. The procedure is entirely painless. Post treatment we infuse a combination of topicals including CS ointments, tacrolimus & other pigment stimulators.
Which is better, a derma roller, stamper or pen for microneedling?
It is the method of execution & not the device that counts. I use a roller for most of my work, my nurses & therapist like derma pens or the Skin Pen, however the safest is a stamping device if you are new to microneedling.
Rolling can give you ‘microtears’ especially if you don’t know what you are doing, or if you use long needles. A pen can do the same, especially if you drag it, or if the motor is stuffed, or if you use long needles. Hence for home use, stick with a stamp. Again, do not go longer than 0.2 mm.
Who should not microneedle?
Microneedling therapy is adjunctive, it is not first line. Progressive, acute, inflammatory vitiligo is a relative contraindication. If this applies to you, see a dermatologist. Do not microneedle the following-
- Genitals, eyelids, lips or your butt hole.
- Areas of infection
- If you have a history of cold sores & don’t have antivirals
- If you are unsure of anything
- Inflamed vitiligo as you can extend it/make it worse
What are the risks of microneedling?
If you don’t know what you are doing, this treatment can damage your skin. Risk includes-
- Infection. Ideally you should microneedle in a sterile environment.
- Worsening of vitiligo. This is called Koebner & is more common in progressive & inflammatory vitiligo.
- Scarring, also known as iatrogenic scars. This happens when you drag you needle, use blunt needles, use long needles, or because you don’t quite know what you are doing.
- Contact dermatitis from the topicals can occur. This is because the skin barrier is compromised.
Where do you get microneedles from?
Most of our microneedles are clinical grade. You can source sensible needle lengths from many online stores. Don’t exceed 0.2 mm. Buy a stamping device. They are far safer than pens or rollers.
What are other adjunctive clinical treatments for vitiligo?
Medical therapy is the mainstay of treatment. This gives the highest chances of success. Dermatologists employ the following methods-
- Creams: include tacrolimus, pimecrolimus, CS, 5FU, PGE analogues, vitamin D creams.
- Narrowband phototherapy is the Gold Standard. 2-3 sessions per week. This treatment provides the fastest rate of re-pigmentation. It is covered under Medicare with no out of pocket expenses.
- Lasers & surgery. These are last line treatments.
What are other adjunctive natural treatments for vitiligo?
Supplements & diets are aimed at reducing inflammation & oxidative stress to the melanocytes. Diets that are low in acidic food & gluten free are trending on Google searches ATM. They are harmless, so if you are inclined, go ahead.
Vitamin B deficiency can be associated with pernicious anaemia. This is an autoimmune disease, like vitiligo. There are low quality studies that have demonstrated the benefits of Vitamin B3, B6 & B12.
Vitamin C is the most potent antioxidant in the body. It is a water-soluble vitamin. If you would like to supplement ascorbic acid, take a tablet and don’t use a cream. Topical vitamin C suppresses your melanocytes, hence will slow down re-pigmentation.
Vitamin D can be used with oral and topical supplementation has shown to be beneficial in some cases of vitiligo.
Ginkgo biloba is another well accepted herbal supplement, there are some studies in the dermatology literature.
Indian gooseberry or Phyllanthus emblica fruit extract, vitamin E, carotenoid combinations can be useful. Given the banal nature of berries, fruits & tocopherol, supplementation may be indicated, as adjunct to phototherapy.
Polypodium leucotomos (PL) is a tropical fern that has been shown to protect against UV radiation– induced damage.
Green tea is another potent antioxidant. Studies are weak, however, as placebo can be useful, supplementation can be considered.
Can natural sunlight be useful following microneedling?
Natural sunlight can be useful as UVB encourages melanin production & melanocyte migration. It can also cause sunburn, making your vitiligo worse. The problem with sunlight is that it also contains UVA, UVB (unlike narrowband UVB) as well as the visible spectrum of light.
If you want maximal UVB, it will be found in the midday sun (UVA is relatively constant). Hence you will require exposure for 2 to 40 minutes depending on where you live.
A more sensible & practical approach is clinical narrowband phototherapy as this gives precise doses of UVB without other spectrums of radiation. This treatment is also bulk billed in Australia for Medicare card holders.
How to get clinical grade microneedling?
Ideally you should see a dermatologist if you are contemplating this treatment. Most dermatologists won’t know about this, unless they read the literature. It has been in print for the past 3 years.
I do believe that microneedling should be viewed as adjunctive therapy and not primary. The use of CS, calcineurin inhibitors & PG analogues with prescribed 311 nm computer controlled narrowband phototherapy is gold standard.
I can assess your vitiligo & decide if this treatment is in you. I have your best interest in mind. I do not do online assessments, either by email or Skype. If you are suitable for treatment, I will book you in.
Note: Microneedling is not covered under Medicare. The only vitiligo therapy covered is phototherapy. Microneedling sessions cost $390 to $590 per session.
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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