Assessing the Efficacy of Needling With or Without Corticosteroids in the Repigmentation of Vitiligo

Vitiligo is an autoimmune cutaneous disorder that destroys melanocytes leading to
depigmented areas of skin. In the United States, vitiligo affects 1% of patients, causing
not only changes in the color of skin, but also significant cosmetic concerns and quality of
life issues. Current treatment modalities, which include topical corticosteroids,
intralesional corticosteroids, phototherapy, and systemic immunosuppression, are variably
effective in inducing repigmentation. Unfortunately, some cases of vitiligo are refractory
to treatment. There is a need for new, effective modalities to treat patients with otherwise
refractory vitiligo.

Needling is an office based procedure that theoretically transposes healthy, pigmented skin
cells to depigmented areas using a needle in vitiligo patients. Two preliminary studies of
needling as a novel treatment for vitiligo had promising results but were limited by small
sample size and subjective results.

The proposed randomized control trial (RCT) will further investigate the use of needling to
treat vitiligo. It differs from the previous studies in that it seeks to identify the cause
of clinical benefit by comparing needling alone to needling with corticosteroid, examines a
larger number of patients, and quantifies improvement using confocal microscopy. Confocal
microscopy (CFM) allows non-invasive visualization of the skin on a cellular level and has
been used in the past to diagnose cutaneous pigmentary conditions. This study would be the
first RCT of needling in vitiligo to use an objective measure to quantify results, thus has
the potential to establish needling as a novel, effective treatment for vitiligo and to
evaluate the utility of CFM for monitoring response to treatment.