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<p>Vitiligo is a chronic skin condition characterized by depigmented patches resulting from the destruction of melanocytes. Topical 5-fluorouracil (5-FU) promotes melanocyte proliferation and migration, while microneedling enhances the absorption of 5-FU by bypassing the epidermis. This systematic review and meta-analysis aim to assess the efficacy and safety of microneedling with topical 5-FU as a potential alternative or adjunct treatment for stable vitiligo cases. We searched multiple databases and included only randomized controlled trials (RCTs) of participants diagnosed with vitiligo who were treated with microneedling combined with topical 5-FU, focusing on studies reporting the effect based on the Vitiligo Area Scoring Index (VASI) score. Studies that were non-RCTs, case reports, or did not focus on vitiligo or microneedling therapy with topical 5-FU, or those involving patients with other skin diseases or not reporting the selected outcomes, were excluded. The primary outcome was the proportion of ≥ 50% repigmentation (clinical significance), and the secondary outcome was the proportion of ≥ 75% repigmentation (excellent response). Six RCTs were included, with 251 patients aged 10 to 64 years, and study durations ranging from 3 months to 1 year. For repigmentation, the experimental group (microneedling with 5-FU) demonstrated significant improvement, particularly in G3 grade (OR 2.26, 95% CI: 1.04, 4.90) and G4 grade (OR: 6.31, 95% CI: 1.91, 20.78). Pain (OR 4.91, 95% CI: 2.55–9.46) and erythema (OR 2.83, 95% CI: 1.59–5.01) also favored the experimental group, with substantial heterogeneity across studies. The overall effect for repigmentation was robust, though variability in study outcomes was noted (Chi² = 28.51, <i>P</i> = 0.0004; I² = 72%). Microneedling combined with topical 5-FU shows promising results for treating vitiligo, especially in long-standing cases that are unresponsive to conventional therapies. Further studies are necessary to refine treatment protocols and determine the optimal dosage of 5-FU for enhanced safety and efficacy.</p>

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Microneedling with topical 5-fluorouracil for vitiligo treatment: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年8月12日

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  • Mohammed Alahmadi,
  • Sara Alghamdi,
  • Shahad Alshehri,
  • Renad Alharthy,
  • Albatool Almajhad,
  • Nouf Alzahrani

摘要

Vitiligo is a chronic skin condition characterized by depigmented patches resulting from the destruction of melanocytes. Topical 5-fluorouracil (5-FU) promotes melanocyte proliferation and migration, while microneedling enhances the absorption of 5-FU by bypassing the epidermis. This systematic review and meta-analysis aim to assess the efficacy and safety of microneedling with topical 5-FU as a potential alternative or adjunct treatment for stable vitiligo cases. We searched multiple databases and included only randomized controlled trials (RCTs) of participants diagnosed with vitiligo who were treated with microneedling combined with topical 5-FU, focusing on studies reporting the effect based on the Vitiligo Area Scoring Index (VASI) score. Studies that were non-RCTs, case reports, or did not focus on vitiligo or microneedling therapy with topical 5-FU, or those involving patients with other skin diseases or not reporting the selected outcomes, were excluded. The primary outcome was the proportion of ≥ 50% repigmentation (clinical significance), and the secondary outcome was the proportion of ≥ 75% repigmentation (excellent response). Six RCTs were included, with 251 patients aged 10 to 64 years, and study durations ranging from 3 months to 1 year. For repigmentation, the experimental group (microneedling with 5-FU) demonstrated significant improvement, particularly in G3 grade (OR 2.26, 95% CI: 1.04, 4.90) and G4 grade (OR: 6.31, 95% CI: 1.91, 20.78). Pain (OR 4.91, 95% CI: 2.55–9.46) and erythema (OR 2.83, 95% CI: 1.59–5.01) also favored the experimental group, with substantial heterogeneity across studies. The overall effect for repigmentation was robust, though variability in study outcomes was noted (Chi² = 28.51, P = 0.0004; I² = 72%). Microneedling combined with topical 5-FU shows promising results for treating vitiligo, especially in long-standing cases that are unresponsive to conventional therapies. Further studies are necessary to refine treatment protocols and determine the optimal dosage of 5-FU for enhanced safety and efficacy.