Optimizing Lip Vitiligo Treatment: The Role of Microneedling with 5-Fluorouracil

Background: Vitiligo is an autoimmune disease characterized by depigmented macules and patches over the skin or mucosa and is of great aesthetic concern. It affects 2% of the world’s population with an average age of 20 years. Lip vitiligo is a distinct focal subtype of vitiligo accounting for 16% of total cases and has a significant impact on life, including lowered self-esteem. Though there are many topical and systemic agents available, it is often resistant to medical treatment, and there is an unmet medical need for novel therapeutic interventions. The aim of this study is to know the efficacy of microneedling with 5-fluorouracil in lip vitiligo. Methods: 25 patients with lip vitiligo were prospectively analyzed for the efficacy of microneedling with 5-fluorouracil, which is done at a 3-week interval for a maximum of six sessions with postprocedure follow-up of 12 weeks. Assessment was done at baseline and thereafter every month using clinical photographs and by subjective assessment score of repigmentation. Results: Out of 25 patients with lip vitiligo, 48% showed excellent response, followed by 24%, 16%, and 12% showing very good, good, and poor response, respectively. The most common side effect noted was pain (80%), followed by oozing and crusting (60%). Conclusion: The integration of microneedling with 5-fluorouracil has emerged as a promising and innovative approach, with reduced side effects and potentially transforming the management of this difficult condition.