الفهرس 
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Abstract
Acral vitiligo includes lesions over wrist, hand, ankle and foot (Mutalik, 2007). Acral lesions of vitiligo are known to resist repigmentation even with surgical treatment (Falabella, 2005). Few reasons for the resistance of the acral areas were suggested. The most popular theory is the relatively lower density or absence of pilosebaceous follicles, the reservoirs from which the melanocytes migrate (Roelandts, 2003). Relatively less melanocyte density as well as higher chances of koebnerization over these friction and injury prone anatomical sites were other suggestions (Mutalik, 2007).
This study aimed to compare between combination of 5-fluorouracil cream with sandpaper technique and sandpaper technique alone in treatment of acral vitiligo. It was conducted at the dermatology clinic of Suez Canal University Hospital at Ismailia city. Thirty patients with acral vitiligo were randomly divided into two equal groups:
group A: was treated “once” with sandpaper technique alone.
The other group B was treated “once” with transfer of melanocytes and epidermal cells obtained using the ”sandpaper method” combined with topical 5% 5-fluorouracil cream. Topical 5% 5-fluorouracil cream was applied to the receptor area once daily for 7 days under occlusion, erythema was noticed by the end of the week, afterwards; Using water sterilized piece of sandpaper, the skin of the recipient area was manually abraded by hand until the pinpoint bleeding became evident. Using another piece of sandpaper, the skin of the donor area was also manually abraded by hand until the pinpoint bleeding became evident. The sandpaper with the epidermal fragments from donor area was then applied to only one of the previously treated areas with topical 5-fluorouracil. A waterproof dressing was applied ensuring that the sandpaper is firmly attached to the recipient site. Lastly; the donor area was cleansed with saline and covered with paraffin gauze, leaving it to heal by secondary intention. Dressings from the recipient and donor areas were left in place for 1 week before being removed. from the day after the bandages were removed, patients received 5 to 10 minutes of direct sun-light daily per week until study completion (6 months).
Vitiligo Disease Activity Score (VIDA) was 0 in all cases, which means that all patients had a stability of greater or equal to 1 year.
Digital photography standardization was set up to record the base line and then monthly after the procedure until the third month of follow up. The degree of repigmentation was evaluated as 5 grades: Grade 0 = 0 %, Grade 1 = 1-25 % Grade 2 = 26-50 %, Grade 3 = 51-75 % and Grade 4 = 76-100 %.
Our findings demonstrated that there is no significant difference between both groups as most of patients (66.7%) of patients in group A & (60%) of patients in group B had no improvement (G0), Grade 1 was noticed in (33.3%) of patients in group A & (40%) of patients in group B. This difference was not statistitically significant.
No complications was observed in most patients of both groups with only one patient in each group who suffered infection treated with systemic antibiotics and resolved in few days. There was another patient in group A, who had transient hyperpigmentation which also resolved gradually during follow up period. Most of cases weren’t satisfied by treatment in both groups, that’s certainly as no one achieved desirable response (grade 3 or 4) thus the treatment of acral vitiligo is even if safe, easy to perform and non costly, it is neither effective using sandpaper technique alone nor using sand paper technique in combination with 5 fluorouracil, although it is proved to be effective in other anatomical areas.
Conclusion :
Using sandpaper technique alone or using sand paper technique in combination with topical 5fluorouracil cream even if safe, easy to perform and non costy, is not effective in the treatment of acral vitiligo, although it is proved to be effective in other anatomical areas.