The efficacy and safety of microneedling combined with tacrolimus versus tacrolimus monotherapy for vitiligo treatment: a systematic review and meta-analysis.

Tacrolimus is a topical immunomodulator that has been used successfully in treating vitiligo; however, recent studies suggested that combining tacrolimus with microneedling (Mn) can increase its efficacy. This systematic review aimed to assess the efficacy and safety of Mn combined with tacrolimus to treat localized and stable nonsegmental vitiligo. We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). The risk ratio (RR) was used to represent dichotomous outcomes, whereas the odds ratio (OR) was used for adverse events. Three randomized control trials (RCTs) (n=148 participants) were deemed eligible. The pooled effect estimate showed a statistically significant higher re-pigmentation rate in all assessed body areas in favor of treatment with Mn combined with tacrolimus (RR=2.02, 95% confidence interval [CI]: 1.51-2.70). Nonetheless, no significant difference was found between Mn combined with tacrolimus and tacrolimus monotherapy in terms of 5-grade repigmentation scale (RR=0.93, 95% CI: 0.53-1.62), histopathological assessment (RR=0.90, 95% CI: 0.47-1.75), and adverse events (OR=1.72, 95% CI: 0.10-29.36). Mn combined with tacrolimus showed a clinically and statistically substantial improvement in the re-pigmentation of vitiligo sites with acceptable tolerability and safety profile.