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

Abstract

The Vitiligo therapy is still a topical issue today. According to the Russian and European clinical guidelines, modern therapy for vitiligo includes UVB-311 nm phototherapy, topical glucocorticoids and topical calcineurin inhibitors. Standard treatment regimens require a long time of application and their effectiveness on the average does not exceed 40%, which leads to disappointment in the treatment not only for patients but also for dermatologists. In this regard an active search for therapies for vitiligo continues. Thus, one of the modern options for the treatment of this disease is microneedling.

Microneedling is a relatively new, easy to perform, safe and minimally invasive therapeutic technique that enhances the regenerative process by creating numerous microtraumas occurring when shallow needles are punctured into the skin. This procedure causes a cascade of reactions similar to the wound healing process, stimulating the production of collagen, elastin and growth factors and increases the migration of melanocytes and keratinocytes leading to repigmentation of vitiligo lesions. Local damage to the skin with needles enhances penetration of active ingredients into deeper layers, so microneedling is often combined with the use of UV light, as well as with various biopharmaceuticals to increase efficiency. Although the procedure is relatively new it has demonstrated efficacy, good tolerability, limited undesirable effects and a short recovery time, making micro-needling a promising treatment for vitiligo.

This article is a review in nature. The purpose of this review is to update the available information on the treatment of vitiligo as well as to explore a promising new method of therapy. A systematic literature review was conducted using PubMed, Cochrane Library, CyberLeninka, Clinicaltrial.govand the open-access Internet databases to examine the efficacy, principles of action, and tolerability of the new treatment. Key words used in the literature search in the aforementioned databases were “vitiligo,” “vitiligo treatment,” “microneedling,” and “quality” of life .The results of various clinical studies are presented.

This review is addressed to practicing dermatovenerologists interested in vitiligo therapy.

Keywords

vitiligo / treatment / microneedling / quality of life

References

[1] Clinical recommendations of the Russian Society of Dermatovenerologists and Cosmetologists. Vitiligo. Moscow; 2020. (In Russ).

[2] Клинические рекомендации Российского общества дерматовенерологов и косметологов. Витилиго. Москва, 2020.

[3] Bergqvist C, Ezzedine K. Vitiligo: A review. Dermatology. 2020;236(6):571–592. doi: 10.1159/000506103

[4] Bergqvist C., Ezzedine K. Vitiligo: a review // Dermatology. 2020. Vol. 236, N 6. Р. 571–592. doi: 10.1159/000506103

[5] Krüger C, Schallreuter KU. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. Int J Dermatol. 2012;51(10):1206–1212. doi: 10.1111/j.1365-4632.2011.05377.x

[6] Krüger C., Schallreuter K.U. A review of the worldwide prevalence of vitiligo in children/adolescents and adults // Int J Dermatol. 2012. Vol. 51, N 10. Р. 1206–1212. doi: 10.1111/j.1365-4632.2011.05377.x

[7] Kussainova A, Kassym L, Akhmetova A, et al. Vitiligo and anxiety: A systematic review and meta-analysis. PLoS One. 2020;15(11):e0241445. doi: 10.1371/journal.pone.0241445

[8] Kussainova A., Kassym L., Akhmetova A., et al. Vitiligo and anxiety: A systematic review and meta-analysis // PLoS One. 2020. Vol. 15, N 11. Р. e0241445. doi: 10.1371/journal.pone.0241445

[9] Liu J, Tang R, Xiao Y, et al. Meta-analytic review of high anxiety comorbidity among patients with vitiligo. Biomed Res Int. 2021;2021:6663646. doi: 10.1155/2021/666364

[10] Liu J., Tang R., Xiao Y., et al. Meta-analytic review of high anxiety comorbidity among patients with vitiligo // Biomed Res Int. 2021. Vol. 2021. Р. 6663646. doi: 10.1155/2021/666364

[11] Lekayon M, Lomonosov KM. Features of the quality of life of patients suffering from vitiligo. Russian journal of skin and venereal diseases. 2022;25(2):119–125. (In Russ). doi: 10.17816/dv106940

[12] Лекайон М., Ломоносов К.М. Особенности качества жизни пациентов, страдающих витилиго // Российский журнал кожных и венерических болезней. 2022. Т. 25, № 2. С. 119–125. doi: 10.17816/dv106940

[13] Taieb A, Alomar A, Böhm M, et al. Vitiligo European Task Force (VETF); European Academy of Dermatology and Venereology (EADV); Union Europe´enne des Me´decinsSpe´cialistes (UEMS). Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2013;168(1):5–19. doi: 10.1111/j.1365-2133.2012.11197.x

[14] Taieb A., Alomar A., Böhm M., et al.; Vitiligo European Task Force (VETF); European academy of dermatology and venereology (EADV); Union Europe´enne des Me´decinsSpe´cialistes (UEMS). Guidelines for the management of vitiligo: The European dermatology forum consensus // Br J Dermatol. 2013. Vol. 168, N 1. Р. 5–19. doi: 10.1111/j.1365-2133.2012.11197.x

[15] Melnikova YG, Lomonosov KM, Gereykhanova LG. Invasive methods of treatment of vitiligo. Russian journal of skin and venereal diseases. 2018;21(2):113–119. (In Russ). doi: 10.18821/1560-9588-2018-21-2-113-119

[16] Мельникова Ю.Г., Ломоносов К.М., Герейханова Л.Г. Инвазивные методы лечения витилиго // Российский журнал кожных и венерических болезней. 2018. Т. 21, № 2. С. 113–119. doi: 10.18821/1560-9588-2018-21-2-113-119

[17] Iriarte C, Awosika O, Rengifo-Pardo M, et al. Review of applications of microneedling in dermatology. Clin CosmetInvestig Dermatol. 2017;10:289–298. doi: 10.2147/CCID.S142450

[18] Iriarte C., Awosika O., Rengifo-Pardo M., et al. Review of applications of microneedling in dermatology // Clin Cosmet Investig Dermatol. 2017. Vol. 10. Р. 289–298. doi: 10.2147/CCID.S142450

[19] Singh A, Yadav S. Microneedling: advances and widening horizons. Indian Dermatol Online J. 2016;7(4):244–254. doi: 10.4103/2229-5178.185468

[20] Singh A., Yadav S. Microneedling: advances and widening horizons // Indian Dermatol Online J. 2016. Vol. 7, N 4. Р. 244–254. doi: 10.4103/2229-5178.185468

[21] Bykanov AS, Snarskaya ES. Microneedling in the threatment of post-acne symptom complex. Russian journal of skin and venereal diseases. 2021;24(1):79–92. (In Russ). doi: 10.17816/dv62216

[22] Быканов А.С., Снарская Е.С. Микронидлинг в терапии симптомокомплекса постакне // Российский журнал кожных и венерических болезней. 2021. Т. 24, № 1. С. 79–92. doi: 10.17816/dv62216

[23] Salloum A, Bazzi N, Maalouf D, Habre M. Microneedling in vitiligo: a systematic review. Dermatol Ther. 2020;33(6):e14297. doi: 10.1111/dth.14297

[24] Salloum A., Bazzi N., Maalouf D., Habre M. Microneedling in vitiligo: a systematic review // Dermatol Ther. 2020. Vol. 33, N 6. Р. e14297. doi: 10.1111/dth.14297

[25] Ziaeifar E, Ziaeifar F, Mozafarpoor S, et al. Applications of microneedling for various dermatologic indications with a special focus on pigmentary disorders: A comprehensive review study. Dermatol Ther. 2021;34(6):e15159. doi: 10.1111/dth.15159

[26] Ziaeifar E., Ziaeifar F., Mozafarpoor S., et al. Applications of microneedling for various dermatologic indications with a special focus on pigmentary disorders: a comprehensive review study // Dermatol Ther. 2021. Vol. 34, N 6. Р. e15159. doi: 10.1111/dth.15159

[27] Zduńska K, Kołodziejczak A, Rotsztejn H. Is skin microneedling a good alternative method of various skin defects removal. Dermatol Ther. 2018;31(6):e12714. doi: 10.1111/dth.12714

[28] Zduńska K., Kołodziejczak A., Rotsztejn H. Is skin microneedling a good alternative method of various skin defects removal // Dermatol Ther. 2018. Vol. 31, N 6. Р. e12714. doi: 10.1111/dth.12714

[29] Nair PA, Arora TH. Microneedling using dermaroller: a means of collagen induction therapy. GMJ. 2014;69:24–27.

[30] Nair P.A., Arora T.H. Microneedling using dermaroller: a means of collagen induction therapy // GMJ. 2014. Vol. 69. Р. 24–27.

[31] Falabella AF, Falanga V. Wound healing. The biology of the skin. New York: Parethenon; 2001. Р. 281–299.

[32] Falabella A.F., Falanga V. Wound healing. The biology of the skin. New York: Parethenon, 2001. Р. 281–299.

[33] Zduńska K, Kołodziejczak A, Rotsztejn H. Is skin microneedling a good alternative method of various skin defects removal. Dermatol Ther. 2018;31(6):e12714. doi: 10.1111/dth.12714

[34] Zduńska K., Kołodziejczak A., Rotsztejn H. Is skin microneedling a good alternative method of various skin defects removal // Dermatol Ther. 2018 Nov. Vol. 31, N 6. Р. e12714. doi: 10.1111/dth.12714

[35] Fabbrocini G, Fardella N, Monfrecola A, et al. Acne scarring treatment using skin needling. Clin Exp Dermatol. 2009;34(8):874–879. doi: 10.1111/j.1365-2230.2009.03291.x

[36] Fabbrocini G., Fardella N., Monfrecola A., et al. Acne scarring treatment using skin needling // Clin Exp Dermatol. 2009. Vol. 34, N 8. Р. 874–879. doi: 10.1111/j.1365-2230.2009.03291.x

[37] Majid I, Sheikh G, September PI. Microneedling and its applications in dermatology. London: Informa Healthcare; 2014. Р. 44–49.

[38] Majid I., Sheikh G., September P.I. Microneedling and its applications in dermatology London: Informa Healthcare, 2014. Р. 44–49.

[39] Serrano G, Almudéver P, Serrano JM, et al. Microneedling dilates the follicular infundibulum and increases transfollicular absorption of liposomal sepia melanin. Clin Cosmet Investig Dermatol. 2015;8:313–318. doi: 10.2147/CCID.S77228

[40] Serrano G., Almudéver P., Serrano J.M., et al. Microneedling dilates the follicular infundibulum and increases transfollicular absorption of liposomal sepia melanin // Clin Cosmet Investig Dermatol. 2015. Vol. 8. Р. 313–318. doi: 10.2147/CCID.S77228

[41] Badran MM, Kuntsche J, Fahr A. Skin penetration enhancement by a microneedle device (Dermaroller) in vitro: dependency on needle size and applied formulation. Eur J Pharm Sci. 2009; 36(4-5):511–523. doi: 10.1016/j.ejps.2008.12.008

[42] Badran M.M., Kuntsche J., Fahr A. Skin penetration enhancement by a microneedle device (Dermaroller) in vitro: dependency on needle size and applied formulation // Eur J Pharm Sci. 2009. Vol. 36, N 4-5. Р. 511–523. doi: 10.1016/j.ejps.2008.12.008

[43] Malik N, Singh Y, Goyal T. A simple office-based procedure for patients with extensive vitiligo. J Am Acad Dermatol. 2016;75(5):e195–e197. doi: 10.1016/j.jaad.2016.02.1243

[44] Malik N., Singh Y., Goyal T. A simple office-based procedure for patients with extensive vitiligo // J Am Acad Dermatol. 2016. Vol. 75, N 5. Р. e195–e197. doi: 10.1016/j.jaad.2016.02.1243

[45] Salloum A, Bazzi N, Maalouf D, Habre M. Microneedling in vitiligo: A systematic review. Dermatol Ther. 2020;33(6):e14297. doi: 10.1111/dth.14297

[46] Salloum A., Bazzi N., Maalouf D., Habre M. Microneedling in vitiligo: a systematic review // Dermatol Ther. 2020. Vol. 33, N 6. Р. e14297. doi: 10.1111/dth.14297

[47] Ebrahim HM, Elkot R, Albalate W. Combined microneedling with tacrolimus vs tacrolimus monotherapy for vitiligo treatment. J Dermatolog Treat. 2021;32(8):999–1004. doi: 10.1080/09546634.2020.1716930

[48] Ebrahim H.M., Elkot R., Albalate W. Combined microneedling with tacrolimus vs tacrolimus monotherapy for vitiligo treatment // J Dermatolog Treat. 2021. Vol. 32, N 8. Р. 999–1004. doi: 10.1080/09546634.2020.1716930

[49] Mumtaz H, Anis S, Akhtar A, et al. Efficacy of tacrolimus versus clobetasol in the treatment of vitiligo. Cureus. 2020;12(12):e11985. doi: 10.7759/cureus.11985

[50] Mumtaz H., Anis S., Akhtar A., et al. Efficacy of tacrolimus versus clobetasol in the treatment of vitiligo // Cureus. 2020. Vol. 12, N 12. Р. e11985. doi: 10.7759/cureus.11985

[51] Bertolani M, Rodighiero E, de Felici Del Giudice MB, et al. Vitiligo: what’s old, what’s new. Dermatol Reports. 2021;13(2):9142. doi: 10.4081/dr.2021.9142

[52] Bertolani M., Rodighiero E., de Felici Del Giudice M.B., et al. Vitiligo: what’s old, what’s new // Dermatol Reports. 2021. Vol. 13, N 2. Р. 9142. doi: 10.4081/dr.2021.9142

[53] Ibrahim ZA, Hassan GF, Elgendy HY, et al. Evaluation of the efficacy of transdermal drug delivery of calcipotriol plus betamethasone versus tacrolimus in the treatment of vitiligo. J Cosmet Dermatol. 2019;18(2):581–588. doi: 10.1111/jocd.12704

[54] Ibrahim Z.A., Hassan G.F., Elgendy H.Y., et al. Evaluation of the efficacy of transdermal drug delivery of calcipotriol plus betamethasone versus tacrolimus in the treatment of vitiligo // J Cosmet Dermatol. 2019. Vol. 18, N 2. Р. 581–588. doi: 10.1111/jocd.12704

[55] Chhabra S, Chahar YS, Singh A. A comparative study of microneedling combined with topical 5-fluorouracil versus microneedling alone in treatment of localized stable vitiligo. Indian J Dermatol. 2021;66(5):574. doi: 10.4103/ijd.ijd_130_21

[56] Chhabra S., Chahar Y.S., Singh A. A comparative study of microneedling combined with topical 5-fluorouracil versus microneedling alone in treatment of localized stable vitiligo // Indian J Dermatol. 2021. Vol. 66, N 5. Р. 574. doi: 10.4103/ijd.ijd_130_21

[57] Khater M, Nasr M, Salah S, et al. Clinical evaluation of the efficacy of trichloroacetic acid 70% after microneedling vs intradermal injection of 5-fluorouracil in the treatment of nonsegmental vitiligo; a prospective comparative study. Dermatol Ther. 2020;33(4):e13532. doi: 10.1111/dth.13532

[58] Khater M., Nasr M., Salah S., et al. Clinical evaluation of the efficacy of trichloroacetic acid 70% after microneedling vs intradermal injection of 5-fluorouracil in the treatment of nonsegmental vitiligo; a prospective comparative study // Dermatol Ther. 2020. Vol. 33, N 4. Р. e13532. doi: 10.1111/dth.13532

[59] Nofal A, Eldeeb F, Shalaby M, et al. Microneedling combined with pimecrolimus, 5-fluorouracil, and trichloroacetic acid in the treatment of vitiligo: a comparative study. Dermatol Ther. 2022;35(3):e15294. doi: 10.1111/dth.15294

[60] Nofal A., Eldeeb F., Shalaby M., et al. Microneedling combined with pimecrolimus, 5-fluorouracil, and trichloroacetic acid in the treatment of vitiligo: a comparative study // Dermatol Ther. 2022. Vol. 35, N 3. Р. e15294. doi: 10.1111/dth.15294

[61] Ozawa M, Ferenczi K, Kikuchi T, et al. 312-nanometer ultraviolet B light (narrow-band UVB) induces apoptosis of T cells within psoriatic lesions. J Exp Med. 1999;189(4):711–718. doi: 10.1084/jem.189.4.711

[62] Ozawa M., Ferenczi K., Kikuchi T., et al. 312-nanometer ultraviolet B light (narrow-band UVB) induces apoptosis of T cells within psoriatic lesions // J Exp Med. 1999. Vol. 189, N 4. Р. 711–718. doi: 10.1084/jem.189.4.711

[63] Hegazy RA, Fawzy MM, Gawdat HI, et al. T helper 17 and Tregs: A novel proposed mechanism for NB-UVB in vitiligo. Exp Dermatol. 2014;23(4):283–286. doi: 10.1111/exd.12369. PMID: 24617827

[64] Hegazy R.A., Fawzy M.M., Gawdat H.I., et al. T helper 17 and Tregs: a novel proposed mechanism for NB-UVB in vitiligo // Exp Dermatol. 2014. Vol. 23, N 4. Р. 283–286. doi: 10.1111/exd.12369

[65] Rodrigues M, Ezzedine K, Hamzavi I, et al.; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol. 2017;77(1):1–13. doi: 10.1016/j.jaad.2016.10.048

[66] Rodrigues M., Ezzedine K., Hamzavi I., et al.; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo // J Am Acad Dermatol. 2017. Vol. 77, N 1. Р. 1–13. doi: 10.1016/j.jaad.2016.10.048

[67] El-Ghorr AA, Norval M. Biological effects of narrow-band (311 nm TL01) UVB irradiation: A review. J Photochem Photobiol. 1997;38(2-3):99–106. doi: 10.1016/s1011-1344(96)07454-4

[68] El-Ghorr A.A., Norval M. Biological effects of narrow-band (311 nm TL01) UVB irradiation: A review // J Photochem Photobiol. 1997. Vol. 38, N 2-3. Р. 99–106. doi: 10.1016/s1011-1344(96)07454-4

[69] Wu CS, Yu CL, Wu CS, et al. Narrow-band ultraviolet-B stimulates proliferation and migration of cultured melanocytes. Exp Dermatol. 2004;13(12):755–763. doi: 10.1111/j.0906-6705.2004.00221.x

[70] Wu C.S., Yu C.L., Wu C.S., et al. Narrow-band ultraviolet-B stimulates proliferation and migration of cultured melanocytes // Exp Dermatol. 2004. Vol. 13, N 12. Р. 755–763. doi: 10.1111/j.0906-6705.2004.00221.x

[71] Cui J, Shen LY, Wang GC. Role of hair follicles in the repigmentation of vitiligo. J Invest Dermatol. 1991;97(3):410–416. doi: 10.1111/1523-1747.ep12480997

[72] Cui J., Shen L.Y., Wang G.C. Role of hair follicles in the repigmentation of vitiligo // J Invest Dermatol. 1991. Vol. 97, N 3. Р. 410–416. doi: 10.1111/1523-1747.ep12480997

[73] Ahmad TJ, Rashid T, Rani Z. Needling: an adjunct to narrowband ultraviolet B therapy in localized fixed vitiligo. J Pakistan Association Dermatologists. 2008;18:149–153.

[74] Ahmad T.J., Rashid T., Rani Z. Needling: an adjunct to narrowband ultraviolet B therapy in localized fixed vitiligo // J Pakistan Association Dermatologists. 2008. Vol. 18. Р. 149–153.

[75] El-Domyati M, Anbar TS, Yehia M, et al. The use of intralesional corticosteroid combined with narrowband ultraviolet B in vitiligo treatment: Clinical, histopathologic, and histometric evaluation. Int J Dermatol. 2022;61(5):582–590. doi: 10.1111/ijd.15940

[76] El-Domyati M., Anbar T.S., Yehia M., et al. The use of intralesional corticosteroid combined with narrowband ultraviolet B in vitiligo treatment: Clinical, histopathologic, and histometric evaluation // Int J Dermatol. 2022. Vol. 61, N 5. Р. 582–590. doi: 10.1111/ijd.15940

[77] Thomas KS, Batchelor JM, Akram P, et al. Randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo: Results of the hi-light vitiligo trial. Br J Dermatol. 2021;184(5):828–839. doi: 10.1111/bjd.19592

[78] Thomas K.S., Batchelor J.M., Akram P., et al. Randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo: Results of the hi-light vitiligo trial // Br J Dermatol. 2021. Vol. 184, N 5. Р. 828–839. doi: 10.1111/bjd.19592

[79] Batchelor JM, Thomas KS, Akram P, et al. Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: Hi-light vitiligo three-arm RCT. Health Technol Assess. 2020;24(64):1–128. doi: 10.3310/hta24640

[80] Batchelor J.M., Thomas K.S., Akram P., et al. Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: Hi-light vitiligo three-arm RCT // Health Technol Assess. 2020. Vol. 24, N 64. Р. 1–128. doi: 10.3310/hta24640

[81] Suntiparpluacha M, Tammachote N, Tammachote R. Triamcinolone acetonide reduces viability, induces oxidative stress, and alters gene expressions of human chondrocytes. Eur Rev Med Pharmacol Sci. 2016;20(23):4985–4992.

[82] Suntiparpluacha M., Tammachote N., Tammachote R. Triamcinolone acetonide reduces viability, induces oxidative stress, and alters gene expressions of human chondrocytes // Eur Rev Med Pharmacol Sci. 2016. Vol. 20, N 23. Р. 4985–4992.

[83] Kim D, Nguyen QT, Lee J, et al. Anti-inflammatory roles of glucocorticoids are mediated by Foxp3+ regulatory T cells via a Mir-342-dependent mechanism. Immunity. 2020;53(3):581–596.e5. doi: 10.1016/j.immuni.2020.07.002

[84] Kim D., Nguyen Q.T., Lee J., et al. Anti-inflammatory roles of glucocorticoids are mediated by Foxp3+ regulatory T cells via a Mir-342-dependent mechanism // Immunity. 2020. Vol. 53, N 3. Р. 581–596.e5. doi: 10.1016/j.immuni.2020.07.002

[85] Li L, Ma Q, Li H. Effect of vitiligo treatment using compound glycyrrhizin combined with fractional carbon dioxide laser and topical triamcinolone acetonide on serum interleukin-17 and tissue growth factor-β levels. J Int Med Res. 2019;47(11):5623–5631. doi: 10.1177/0300060519871382

[86] Li L., Ma Q., Li H. Effect of vitiligo treatment using compound glycyrrhizin combined with fractional carbon dioxide laser and topical triamcinolone acetonide on serum interleukin-17 and tissue growth factor-β levels // J Int Med Res. 2019. Vol. 47, N 11. Р. 5623–5631. doi: 10.1177/0300060519871382

[87] Khashaba SA, Elkot RA, Ibrahim AM. Efficacy of NB-UVB, microneedling with triamcinolone acetonide, and a combination of both modalities in the treatment of vitiligo: A comparative study. J Am Acad Dermatol. 2018;79(2):365–367. doi: 10.1016/j.jaad.2017.12.054

[88] Khashaba S.A., Elkot R.A., Ibrahim A.M. Efficacy of NB-UVB, microneedling with triamcinolone acetonide, and a combination of both modalities in the treatment of vitiligo: A comparative study // J Am Acad Dermatol. 2018. Vol. 79, N 2. Р. 365–367. doi: 10.1016/j.jaad.2017.12.054

[89] Khojah HM, Alharbi AG, Alshaeri AA, et al. Impact of narrow-band ultraviolet B radiation therapy on the quality of life of patients with vitiligo. J Taibah Univ Med Sci. 2021;16(6):843–848. doi: 10.1016/j.jtumed.2021.04.012

[90] Khojah H.M., Alharbi A.G., Alshaeri A.A., et al. Impact of narrow-band ultraviolet B radiation therapy on the quality of life of patients with vitiligo // J Taibah Univ Med Sci. 2021. Vol. 16, N 6. Р. 843–848. doi: 10.1016/j.jtumed.2021.04.012

[91] Neinaa YM, Lotfy SS, Ghaly NR, et al. A comparative study of combined microneedling and narrowband ultraviolet B phototherapy versus their combination with topical latanoprost in the treatment of vitiligo. Dermatol Ther. 2021;34(2):e14813. doi: 10.1111/dth.14813

[92] Neinaa Y.M., Lotfy S.S., Ghaly N.R., et al. A comparative study of combined microneedling and narrowband ultraviolet B phototherapy versus their combination with topical latanoprost in the treatment of vitiligo // Dermatol Ther. 2021. Vol. 34, N 2. Р. e14813. doi: 10.1111/dth.14813

[93] Stanimirovic A, Kovacevic M, Korobko I, et al. Combined therapy for resistant vitiligo lesions: NB-UVB, microneedling, and topical latanoprost, showed no enhanced efficacy compared to topical latanoprost and NB-UVB. Dermatol Ther. 2016;29(5):312–316. doi: 10.1111/dth.12363

[94] Stanimirovic A., Kovacevic M., Korobko I., et al. Combined therapy for resistant vitiligo lesions: NB-UVB, microneedling, and topical latanoprost, showed no enhanced efficacy compared to topical latanoprost and NB-UVB // Dermatol Ther. 2016. Vol. 29, N 5. Р. 312–316. doi: 10.1111/dth.12363

[95] Gowda A, Healey B, Ezaldein H, Merati M. A systematic review examining the potential adverse effects of microneedling. J Clin Aesthet Dermatol. 2021;14(1):45–54.

[96] Gowda A., Healey B., Ezaldein H., Merati M. A systematic review examining the potential adverse effects of microneedling // J Clin Aesthet Dermatol. 2021. Vol. 14, N 1. Р. 45–54.

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Olisova O.Y., Nikulina A.S., Krotkova E.A., Lazareva P.I., Lomonosov K.M.