The use of intralesional corticosteroid combined with narrowband ultraviolet B in vitiligo treatment: clinical, histopathologic, and histometric evaluation

Abstract

Background Treatment of vitiligo with intralesional steroid (ILS) injections has shown to be successful in quite a few studies. It is a simple and safe treatment when used with caution with a better response in localized lesions. ObjectivesThe aim of the present study is to explore the efficacy and safety of using different concentrations of intralesional corticosteroid combined with NB-UVB phototherapy in the treatment of non-segmental vitiligo (NSV) patients.Methodology Twenty patients with non-segmental vitiligo were subjected to different concentrations of ILS injections (triamcinolone acetonide); that was carried out monthly for six sessions. All patients were also subjected to twice-weekly sessions of NB-UVB for 6 months. Punch biopsy was taken from each patch before and at the end of treatment sessions. Each biopsy was stained with hematoxylin and eosin (H&E), Orcein, and Masson's trichrome stains. ResultsThere was a significant difference between all groups in their repigmentation response (P = 0.017). After treatment, the epidermal thickness (histometry) was decreased (epidermal atrophy), especially with concentrations of 2.5 and 5 mg/ml of intralesional triamcinolone acetonide injection with decreased and disorganized collagen fibers. ConclusionIntralesional corticosteroid injections combined with NB-UVB showed a good and well-tolerated therapeutic option for vitiligo. The concentrations of 0.625 and 1.25 mg/ml of triamcinolone acetonide were the safest with fewer side effects and complications. However, higher concentrations of 2.5 and 5 mg/ml were more effective but with more side effects.

Comparative Study between the Efficacy of Trichloroacetic Acid 30% versus Intradermal 5 Fluorouracil Injection in Treatment of Vitiligo with or without Narrow Band Ultraviolet B Phototherapy

“…Good and excellent response rates were noticed in combined therapy group only. Moreover, El-Domyati et al [18] revealed that intralesional corticosteroid injections combined with NBUVB demonstrated a good and well-tolerated treatment modality in the context of vitiligo.…”

Possibilities of microneedling in the combined therapy of vitiligo. Literature review

“…Эффективность сочетания глюкокортикоидов с УФБ-терапией при лечении витилиго подтверждена в исследованиях неоднократно [38][39][40]. Известно, что триамцинолон способен уменьшать прогрессирование заболевания за счёт противовоспалительного эффекта, изменения экспрессии генов, ответственных за оксидативный стресс, влияния на апоптоз клеток и функцию регуляторных Т-клеток, способствуя репигментации [41,42], а микронидлинг, в свою очередь, облегчает всасывание препарата [43].…”