الفهرس 
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Abstract
Acral vitiligo is a resistant form of vitiligo that does not respond significantly to medical treatment. Narrow band -UVB has a confirmed treatment effect on vitiligo. Platelet-rich plasma (PRP) is an autologous preparation which contains a variety of growth factors. PRP with or without microneedling were found to be beneficial in the initiation of repigmentation in vitiligo. However, their combined effect on acral vitiligo has been rarely reported.
The present study was designed to evaluate the effect of combining NB-UVB with microneedling followed by PRP versus NB-UVB with microneedling only in the treatment of acral vitiligo of the hands and feet.
Forty two patients with stable non segmental vitiligo, acral in distribution, attending the outpatient clinic of the Department of Dermatology, Venereology and Andrology, Assiut University Hospitals were included in the present study.
In the present study, acral vitiligo lesions on the hand and feet were treated with monthly micro-needling followed by PRP (group A) on one side while the other side was treated with micro-needling only (group B) monthly for 3 months for both groups. All patients received twice weekly sessions with narrow band UVB for 3 months.
All patients were evaluated at the baseline, before every session, 1 month after last session and only 26 patients were evaluated 3 months after the last session.
The mean age of patients’ ± SD was 30.10 ± 15.07 years with a range of 18.0-66.0 years, 18 patients (42.9%) were males and 24 patients (57.1%) were females.
Fifteen patients (35. 7 %) had skin type III while 27 (64.3%) patients were of skin type IV. The mean duration of the disease was 8.48 ± 5.52 years with a range of 1- 20 years, and disease stability duration was 17.88 ± 19.45 months with a range of 3.0-84.0 months.
The mean VASI score before treatment of patients was 0.17 ± 0.23 with a range (0.05-0.10). The mean number of treated lesions for each patient was 4.09 ± 2.89 with a range (1.5 – 5).
Of the 769 treated lesions, 702 (91, 3%) were at hands and 67 (8.7%) were at feet. Lesions at the hands was divided into 4 sites (periungual 28.3 %, knuckle 29.4%, inversed knuckle 16.3% and dorsum of the hands 17.3%), while feet lesions were divided into 3 sites (lateral side 2.2%, medial side 2.3 % and dorsum of the foot 4.2%.
One month after the third session of treatment, high percent of repigmentation was reported in 87.1% of hand lesions treated with PRP, needling and NB-UVB compared to 85.3% of lesions treated with needling and NB-UVB. Also, repigmentation of feet lesions was reported in 94.02% in the PRP group compared to 89.55% in the control group, with no significant difference.
Both grade and mean percent of repigmentation for hand lesions were comparable in the both sides. Excellent and good grade of repigmentation were reported in 15.7%, 12.0% in the PRP group compared to 14.5%, 12.0% in the control group. Similarly, the mean percent of repigmentation in the PRP and the control groups (23.49 ± 34.03 vs. 23.92 ±33.32) were close to each other (P value > 0.05).
As regard the feet lesions, the mean percent of repigmentation in the PRP group was higher than that in the control group (34.09 ± 26.25 vs. 22.73 ± 28.05) with no significant difference between them. Excellent and good grade of response was noted in 9.1 % and 27.3% in the PRP group compared to 9.1 % excellent and 27.3%, good response in the control group.
Also, there was no significant difference in the mean value of VASI score, the percentage of VASI change, the mean number of treated lesions for each patient as well as color matching between group A and group B 1month after the last session for vitiligo lesions in the hands and feet.
However, a significant improvement of the VASI score as well as significant reduction in the number of treated lesions were noticed in both treated lesions of the hands and feet in comparison to that before treatment.
By comparing the percentage of repigmentation in each group for different treated sites, a significant higher percentage of repigmentation was reported in the dorsum of the hands as compared to the knuckles, inversed knuckles and periungual. Among feet lesions, a non-significant higher percentage of repigmentation was noticed in the lateral site in comparison to the dorsum and medial side of the feet.
Also, no significant difference was observed as regards percent of repigmentation, VASI score, number of lesions and color match in different treated sites between the PRP and the control group.
Among our studied patients with acral vitiligo of the hand and feet, 26 patients were followed up 3 months after the last treatment session to determine stability of the results.
Three months after the last session of treatment, the changes in the mean percentage of repigmentation, VASI score and number of treated.