Background:Microneedling is a valuable tool that can be used in transdermal drug delivery in vitiligo patients to improve drug permeability and efficacy with minor side effects. Aims:The aim of this study is to assess the effectiveness of using microneedling prior to application of topical 5-FU in treatment of localized vitiligo and to compare its results with microneedling alone. Methods:Twenty-seven patients with localized stable vitiligo are chosen. Two patches are determined in every patient: patch A treated with needling alone and patch B treated with needling followed by topical application of 5-fluorouracil once every 2 weeks for three months. Repigmentation was accessed by grades ranging from G0; no response to G4; >75% repigmentation. Side effects were reported in every visit. Results:Microneedling followed by topical application of 5-fluorouracil showed better response than needling alone with minimal side effects. Conclusion:Combining microneedling with topical drug application yields better results in treating localized vitiligo. K E Y W O R D S 5-fluorouracil, needling, vitiligoHow to cite this article: Attwa EM, Khashaba SA, Ezzat NA.Evaluation of the additional effect of topical 5-fluorouracil to needling in the treatment of localized vitiligo. J Cosmet