Comparative study between intralesional vitamin D versus 5- fluorouracil in treatment of recalcitrant vitiligo

Background Vitiligo, affecting 1–2% of people globally, leads to loss of skin pigmentation and can cause psychological distress. Treatment focuses on stopping its spread and restoring color, typically through topical agents, phototherapy, and systemic treatments like oral corticosteroids and Janus kinase inhibitors. Recent research suggests vitamin D and 5-fluorouracil (5-FU) injections may be effective, with vitamin D improving outcomes when combined with phototherapy, and 5-FU potentially shortening therapy duration and enhancing results. The objective of this study was to evaluate and compare the effectiveness and safety of intralesional vitamin D versus intralesional 5-FU in managing persistent vitiligo. Patients and methods This study was conducted on 40 patients with bilateral symmetrical recalcitrant vitiligo not responding to any treatment modality. It was a prospective, single-blinded, comparative study. Results The study compared intradermal injections of 5-FU and vitamin D in 40 patients with stable recalcitrant vitiligo, with 55% under 20. It found 5-FU more effective, leading to follicular repigmentation in 65% of cases and higher patient satisfaction, while vitamin D caused burning in all patients and had more side effects. The effectiveness of 5-FU was not significantly affected by sex, age, habits, family history, skin type, or onset duration. Conclusion Intralesional injection of 5-FU is an effective and cosmetically acceptable treatment for vitiligo in all age groups. It offers superior repigmentation compared with vitamin D and serves as a safer alternative or complement to existing treatments, with fewer side effects.