Alhamd treatment of vitiligo, a study of needling+ excimer laser @308nm

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Introduction: Vitiligo is a chronic autoimmune disorder where pigment producing cells in skin called melanocytes are attacked and destroyed causing milky white patches in skin. Our study to treat vitiligo is a combination of EXCIMER LASER @308nm,1,2,3 + NEEDLING.4 This study is based on a theme that the melanocytes in the normal skin around the vitiligo patch can be pushed into the Vitiligo patch and subsequent EXCIMER induced melanogenesis treats vitiligo.5 Methods: We use a 30G, 4mm stem needle. Push it through the normal skin into the vitiligo patch at the level of the D-E junction parallel to the skin. This needle push called NEEDLING drags epidermal cells including melanocytes as micro inoculation to produce multiple small populations of melanocytes in the vitiligo area,6 which is then exposed to EXCIMER to cause melanogenesis and hence repigmentation of the area.3,5,7 Multiple needle pushes are made through normal skin around the vitiligo patch, into the vitiligo patch. These needle pushes are done 1cm apart. All patients are having needling once weekly and EXCIMER 2-3 times per week.4,6 A study of this combination was done over 50 patients, in both sexes in different age groups from October 2021 to September 2022 and follow up still continued. A comparison was also done with EXCIMER alone (without needling) in some of these patients at some patches.8 Inclusion and exclusion criteria, a result criteria and a study Performa with follow-up details was set. Photos of all the patients were taken before treatment and then every 3 weeks. Results: Our combination treatment has proved very effective for vitiligo as compared to EXCIMER alone. Most patients had fast repigmentation. The best results are on the face and trunk4,6 with more then 90% repigmentation in all age groups. Repigmentation is good but slow towards peripheral parts.9,10 Repigmentation was specially noticed to start from the edge of the vitiligo patch (where needling is done) as tiny black dots and further needling through these dots gradually repigmented the central areas.4 (Figure 2, 3, 4, 6). Repigmentaion is also good over areas with grey hair with this technique as needling uses melanocytes of the skin surrounding the vitiligo patch rather than the follicular cells. This further strengthened the idea of needling as a useful combination with EXCIMER.