Introduction

Vitiligo is a chronic skin disorder characterized by melanocyte loss, with treatment aiming to induce repigmentation and maintain disease stability. Microneedling enhances transdermal drug delivery, potentially improving treatment outcomes when combined with topical agents.

Aim

This study evaluates and compares the efficacy and safety of microneedling combined with 5-fluorouracil (5-FU), trichloroacetic acid (TCA), and botulinum toxin-A (BTX-A) in vitiligo treatment.

Material and methods

This interventional comparative clinical trial included 60 patients with stable non-segmental vitiligo, randomly assigned into three groups: group I (5-FU, n = 20), group II (TCA, n = 20), and group III (BTX-A, n = 20). Microneedling was performed before applying the respective agents. Treatments were administered biweekly for six sessions, with efficacy assessed using the VASI, VIDA, and PGA scores, as well as patient satisfaction.

Results

Baseline characteristics were comparable across groups (p > 0.05). Post-treatment VASI scores showed a significant improvement in all groups (p < 0.001), with the highest reduction in group I (50%), followed by group II (29%) and group III (5%) (p < 0.001). PGA revealed significantly higher repigmentation in group I (40% good, 35% moderate, 10% excellent) than in group II (p = 0.021) and group III (p < 0.001). Patient satisfaction was the highest in group I (50% very satisfied), followed by group II (45% satisfied), and 75% of group III reporting dissatisfaction (p < 0.001).

Conclusions

Microneedling combined with 5-FU showed the highest efficacy, followed by TCA, while BTX-A was the least effective. This approach offers a safe and promising adjunct for vitiligo treatment, achieving faster repigmentation and improving patient adherence.