Vitiligo is a chronic skin disorder in which skin loses pigment or color and foms white patches. The illness has a significant relapse rate and severely impacts the quality of life. The primary sign of vitiligo is depigmentation, or the loss of natural color or pigment. Depigmented patches can form anywhere on body and may affect the hands, feet, arms, & face. However, the patches may emerge wherever. Hair can turn white as the skin loses color. This can occur on the scalp, brows, eyelashes, beard, and body hair. It also effect mucous membranes of the nose and mouth .1-2 Individuals with vitiligo suffer low self-esteem. The worldwide prevalence of this disorder is  0.5% - 2%, with rates reported changing geographically, according to a self-reported study undertaken in Europe, Japan, and the United States (US), surveying individuals aged 18 and above in an online global survey.3 This condition often manifests before the age of 20, however it can occur at any age. Dyschromia presents as depigmented macules due to a lack of melanocytes in the cutaneous epidermis or an inability to produce melanin. This is caused by a deficiency of the tyrosine enzyme in melanocytes, which initiates the pigment synthesis process. The psychological & emotional toll that this condition takes on those affected is enormous, therefore creating novel, better-suited treatment choices is critical.1 Vitiligo has a complicated pathophysiology, and the specific cause is yet unknown. It was proposed that several elements, particularly hereditary effects, stress, autoimmune susceptibility, defective metabolic route, and trauma, may operate synergistically in the removal of melanocytes from the skin.4-5 Vitiligo is more than simply a cosmetic problem but it is accompanied by social discrimination and shame, resulting in an unbearable psychological burden for affected people.1,2 There are six different therapy techniques available to treat vitiligo, but none of them produce long-term remission in this unpredictable condition. Tacrolimus (T) is a topical immunomodulator that suppresses calcineurin. It has been used effectively to cure vitiligo. Tacrolimus suppresses T-cell activation and can be utilized as an adjuvant or substitute to topical steroids to prevent the related adverse effects that may emerge from its long-term usage.6 Microneedling (Mn) allows for the administration of medicines and bigger protein molecules via the epidermis. The gadget features small needles that generate microchannels in the skin. Furthermore, Mn promotes the release of growth factors, which are necessary for skin regeneration.7 A new method involving needling demonstrated satisfactory degrees of repigmentation.6  It can be done with simple injection needles or microneedling tools including manual rollers, dermarollers, automated needle pen devices, even microneedling fractional radiofrequency devices.7 Microneedling is superior than simple needles in managing penetration depth, hence avoiding  pain  after injection.8 It generates micro-inflammation in the epidermal layer, which increases melanocyte and keratinocyte migration and promotes vitiligo repigmentation. Furthermore, it promotes effective melanocyte grafting from pigmented to unpigmented regions and enhances topical drug penetration into the skin.9 Calcipotriol, a synthetic vitamin D3 analog, enhances calcium absorption and immunity in vitiliginous lesions. It is effective alone or in combination with betamethasone.10 Microneedling, a new dermatological method, can improve topical medication absorption for pigmentation diseases such as vitiligo, especially in darker skin types. 11   The present study was conducted assess the effectiveness of micro needling combined with calcipotriol plus betamethasone in managing vitiligo.

The present prospective experimental study was carried out at Aesthetic Department PAF Hospital, Islamabad for a period of six months from December 2025 to May 2026 after taking approval from the ethical committee of the institute. The sample small size was determined using the WHO calculator. A total of 67 individuals with Vitiligo (no advancement of lesions for at least 2 years, up to 5 patches, and a diameter of less than 10 cm.) of both genders and different age groups (ranged 16-46 years) had no local infections and had not had any local or systemic treatment over the preceding 6 months. Individuals having current infection, bleeding problems, keloidal propensity, or immunocompromised status were excluded. The procedure involved using a 1.5 mm dermapen to make multiple parallel strokes from one border to another, resulting in tiny, punctate bleeding points. The affected area was then treated with calcipotriol plus betamethasone topically and rubbed for about 2 minutes. An occlusive dressing was applied and left on for 1 day. The procedure was repeated every 15 days until repigmentation. The VASI score was used to measure treatment outcomes for vitiligo After therapy, patients were followed up after two weeks to assess the outcome.. Body parts were categorized as hands, upper extremities, trunk, lower extremities, and feet. The hand unit, which includes the palm and digits, accounts for approximately 1% of the body's surface and can help determine baseline vitiligo involvement. Follow-ups measured repigmentation and residual depigmentation inside patches to the closest percentage (0%, 10%, twenty-five percent, fifty 90%, or a hundred percent). VASI scores were calculated for each region using defined criteria: Depigmentation was classified as 100% lack of pigment, 90% specks, 75% depigmented regions exceeding pigmented areas, 50% equal areas, 25% pigmented areas exceeding depigmented areas, and 10% depigmentation specks. Data collection included variables such as age, gender, family history, vitiligo length, and educational status. Data was analyzed through SPSS version 22. We used mean±standard deviation (SD) to summarize numerical factors such as age, disease duration, VASI score at baseline and follow-up, and VASI score change. Categorical data, including gender, levels of education, and familial record of vitiligo, were provided as frequencies and percentages. To account for possible impact modifiers, data was stratified by age, gender, illness duration, educational status, or family history of vitiligo. After stratification, t-tests were used to determine statistically significant differences (p-value ≤0.05).

A total of 67 individuals with vitiligo were included in this study out of which males were 31 (46.3%) and 36 (53.7%) females. The mean age of the study population was 25.3 ± 7.8 years. majority of the participants were below 30 years 45 (67.2%) while 22 (32.8%) were aged 30 years or older. Regarding educational status, 21 (31.3%) patients were illiterate, 16 (23.9%) had middle-level education, 13 (19.4%) were matriculated, and 17 (25.4%) had intermediate or higher education.40 (59.7%) of the individuals had disease duration less than five years 27 (40.3%) had 5 years or above. the mean duration of the disease was 4.45 ± 1.72 years. 48 (71.6%) of the individuals had no family history of vitiligo while 19 (28.4%)  had positive family history of vitiligo as shown in table 1. Among the 67 study participants the mean baseline VASI score was 70.40 ± 8.17. Following treatment with microneedling combined with calcipotriol plus betamethasone, the mean VASI score decreased to 31.74 ± 9.05 at follow-up. The mean reduction in VASI score was 38.66 ± 4.97, showing substantial clinical improvement in the extent of depigmentation after treatment. The paired-sample t test revealed a statistically significant difference between baseline and follow-up VASI scores (p < 0.001), signifying that the management was associated with significant repigmentation as presented in table 2. Patients with lower education levels improved by 39.56 ± 5.29, whereas those with higher education improved by 39.74 ± 4.58.The mean VASI improvement among individuals with a positive family history was 39.24 ± 6.39, whereas that of patients without a family history was 39.79 ± 4.38. The mean improvement in VASI was 39.57 ± 5.88 for male patients and 39.70 ± 4.16 for female patients. The mean improvement in VASI was 39.65 ± 5.14 for individuals under 30 and 39.63 ± 4.77 for those over 30. The mean improvement was 39.75 ± 5.19 for those with less than five years of illness, and 39.47 ± 4.74 for individuals with more than five years. Overall, age, gender, length of illness, family history, and educational status did not significantly affect treatment response (all p>0.05). This implies that the improvement in VASI after micro needling in conjunction with betamethasone and calcipotriol was comparatively constant throughout these variables (table 3).

Vitiligo is a depigmentary disorder that causes progressive loss of melanocytes in the skin and mucous membranes. It causes milky white macules and patches and has a global prevalence ranging from 0.5 to 2.0 percent. It primarily affects people under 20 years old, with a reported prevalence of 4.4% in Pakistan.12 Treatment options for vitiligo vary according on individual age, vitiligo form, lesion stage, location, and distribution, with the goal of inducing repigmentation and stopping disease development. Research indicates that vitiligo is caused by elevated anti-melanocyte antibodies and imbalanced T-cell subsets. Betamethasone, a powerful glucocorticoid steroid, has anti-inflammatory and immunosuppressive properties that promote melanocyte reactivation & repigmentation. Calcipotriol, a synthetic vitamin D3 analog, has been shown to increase calcium absorption and modify immunity in vitiliginous lesions. It can be used alone or in combination with betamethasone.10 Microneedling, a new dermatological method, can improve topical medication absorption for pigmentation diseases such as vitiligo, especially in darker skin types.11 The current study assessed the clinical outcomes of a microneedling combination with calcipotriol and betamethasone in 67 individuals with vitiligo. The mean age of the study population was 25.3 ± 7.8 years. According to Zahoor et al. 10, vitiligo patients at Mayo Hospital Lahore had an average age of 26.3 ± 13.0 years which support out study. Similarly Habib et al., found a mean age of 27.0±18.3 years among patients at CMH in Abbottabad.11 In our study males were 46.3% and 53.7% were females. These findings are similar to the study conducted by Habib et al. In their study females were predominance with a ratio of 1:1.2.11 In our study 48 (71.6%) of the individuals had no family history of vitiligo while 19 (28.4%) had positive family history of vitiligo. Our study findings are similar to the study conducted by Zandi et al.in Iran in which they detected a comparable frequency of positive family history (28.8%) which support our results.14 But our study results were not in line with the study completed by AL Fahaad et al in KSA they experienced a much lower incidence of 5.9%.15 In our study the mean baseline VASI score was 70.40 ± 8.17. Following treatment with micro-needling combined with calcipotriol plus betamethasone, the mean VASI score decreased to 31.74 ± 9.05 at follow-up. The mean reduction in VASI score was 38.66 ± 4.97, showing substantial clinical improvement in the extent of depigmentation after treatment. The current mean VASI improvement of 38.8% is similar to a recent Pakistani research by Manzoor et al., who found a mean VASI change of 39.65 ± 4.97 after three months of microneedling, calcipotriol, and betamethasone treatment.16 The rather favorable response reported in the current iteration is consistent with Ibrahim et al.'s findings. In a 25-patients comparative trial, microneedling combined with calcipotriol + betamethasone demonstrated good improvement in 60% of treated lesions and outperformed micro-needling when used with tacrolimus. The authors also documented effectiveness in difficult sites such as elbows, knees, extremities, and acral regions.16 The response pattern in this trial further suggests the potential use of combination treatment over a single topical drug. Previous research suggests that combining calcipotriol and betamethasone may result in quicker or higher repigmentation than using either drug independently.17 Our study evaluated that age, gender, length of illness, family history, and educational status did not significantly affect treatment response (all p>0.05). This indicates that the improvement in VASI after micro needling in conjunction with betamethasone and calcipotriol was comparatively constant throughout these variables. Similar results were obtain from the study Manzoor et al in which none of the mentioned variables affected treatment procedure which support our study.16 This study contributes to the limited scientific evidence available on the issue. Our study found that combining microneedling with calcipotriol and betamethasone resulted in a significant improvement in the mean VASI score in vitiligo patients. The safety and simplicity of the treatment make it a preferred option for managing such patients in dermatological practice. Limitations of the study This study has several limitations. The study lacks a parallel control group, has a short follow-up time, and relies heavily on VASI to determine response. As a result, long-term repigmentation persistence and comparative effectiveness with phototherapy or other conventional treatments could not be determined.

The study concluded that microneedling with calcipotriol and betamethasone resulted in a significant mean change in VASI score in individuals with vitiligo. The safety and simplicity of the treatment make it a preferred option for managing such individuals’ in future dermatological practice.