Evaluation of the therapeutic efficacy of platelet-rich plasma combined with microneedling and narrowband ultra violet B in acral vitiligo: a right-left comparative study

Background Acral vitiligo is usually more resistant to medical management due to minimal density of hair follicles and greater chance of repeated friction or trauma. Objective: To determine efficacy and safety of adding topical platelet rich plasma (PRP) to automated micro needling and narrow band ultra violet B (NB-UVB) in treatment of resistant acral vitiligo and to assess the best treated sites with this combination therapy. Patients and methods A total of 42 patients with stable acral vitiligo were recruited. lesions at the hand were classified according to their sites into (Dorsum, periungual, knuckles, and inversed knuckles) while lesions at the feet were classified into (Dorsum, lateral side, and medial side of the feet). One side was treated with automated micro needling and topical PRP (group A) and the other side with automated micro needling only (group B) twice monthly for 3 months. Both sides received NB-UVB phototherapy twice weekly. Results One month after the last session, in both groups A and B, The best response was noticed at the dorsum of the hands, regimentation percent = 38.95±39.81 and 42.11±33.51, respectively, followed by inversed knuckles 28.42±37.01 and 25.53±37.19, while no significant difference was noted in comparing between group A and B either at the hands or the feet lesions, regarding the percent of regimentation. The percent of change in vitiligo area scoring index, change in the number of the lesions and color match. Conclusion Adding PRP to NB-UVB and micro needling has no significant advantage in treating patients with resistant acral vitiligo. The response to treatment is best in areas with hair follicles as the dorsum of the hand and inversed knuckles, while areas over bony prominences (knuckles) and devoid of hair follicles (periungual) are resistant to this combination therapy.