Microneedling and 5‐flurouracil can enhance the efficacy of non‐cultured epidermal cell suspension transplantation for resistant acral vitiligo

Acral vitiligo is often resistant to medical and surgical treatments. Non-cultured epidermal cell suspension (NCES) transplantation is a common surgical therapeutic modality for vitiligo. 5-Flurouracil (5-FU) in combination with microneedling has been found to be useful in treating vitiligo. To evaluate the efficacy of NCES transplantation either alone or following microneedling and topical 5-FU for resistant acral vitiligo. This study included 50 patients with resistant acral vitiligo allocated into two groups; group A received only NCES transplantation, and group B received microneedling and topical 5-FU 1-2 weeks prior to NCES transplantation. All patients were monitored for 24 weeks to evaluate the repigmentation response and the immunohistochemical expression of Human Melanoma Black-45 (HMB-45). At 24 weeks, the repigmentation response was significantly higher in the combination group than in the monotherapy group (p = 0.029). Moreover, the percentage of patients with successful repigmentation of 75% or greater was significantly higher in the combination group (84%) than in the monotherapy group (40%) (p = 0.001). Furthermore, lesional skin showed a significant increase in the number of active HMB+ melanocytes in both groups but without any significant difference between the two groups. However, the color intensity of HMB-45 immunostaining was significantly higher in the combination group compared to the monotherapy group (p = 0.012). There was no significant difference between the two groups regarding the adverse effects. The repigmentation response of resistant acral vitiligo to NCES transplantation could be enhanced by prior microneedling followed by topical 5-FU.