{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:39:06Z","timestamp":1790653146542,"version":"4.1.0"},"reference-count":23,"publisher":"PAGEPress Publications","issue":"3","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dermatol Reports"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.4081\/dr.2025.10166","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T07:42:35Z","timestamp":1740123755000},"source":"Crossref","is-referenced-by-count":1,"title":["The efficacy and safety of microneedling combined with tacrolimus &lt;i&gt;versus&lt;\/i&gt; tacrolimus monotherapy for vitiligo treatment: a systematic review and meta-analysis"],"prefix":"10.4081","volume":"17","author":[{"given":"Hadeel A.","family":"Maaddawi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz A.","family":"Aljuaid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9874-9322","authenticated-orcid":false,"given":"Awadh M.","family":"Alamri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhaifallah H.","family":"Alghowairi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah S.","family":"Bawazeer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"31929","doi-asserted-by":"crossref","unstructured":"1. Faria AR, Tarl\u00e9 RG, Dellatorre G, et al. Vitiligo \u2013 Part 2 \u2013 classification, histopathology and treatment. An Bras Dermatol 2014;89:784-90.","DOI":"10.1590\/abd1806-4841.20142717"},{"key":"31930","doi-asserted-by":"crossref","unstructured":"2. Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology 2020;236:571-92.","DOI":"10.1159\/000506103"},{"key":"31931","doi-asserted-by":"crossref","unstructured":"3. Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet 2015;386:74-84.","DOI":"10.1016\/S0140-6736(14)60763-7"},{"key":"31932","doi-asserted-by":"crossref","unstructured":"4. Kr\u00fcger C, Schallreuter KU. Stigmatisation, Avoidance Behaviour and Difficulties in Coping are Common Among Adult Patients with Vitiligo. Acta Derm Venereol 2015;95:553-8.","DOI":"10.2340\/00015555-1981"},{"key":"31933","doi-asserted-by":"crossref","unstructured":"5. Felsten LM, Alikhan A, Petronic-Rosic V. Vitiligo: a comprehensive overview Part II: treatment options and approach to treatment. J Am Acad Dermatol 2011;65:493-514.","DOI":"10.1016\/j.jaad.2010.10.043"},{"key":"31934","doi-asserted-by":"crossref","unstructured":"6. Anbar TS, Hegazy RA, Picardo M, Taieb A. Beyond vitiligo guidelines: combined stratified\/personalized approaches for the vitiligo patient. Exp Dermatol 2014;23:219-23.","DOI":"10.1111\/exd.12344"},{"key":"31935","doi-asserted-by":"crossref","unstructured":"7. Abd-Elazim NE, Yassa HA, Mahran AM. Microdermabrasion and topical tacrolimus: A novel combination therapy of vitiligo. J Cosmet Dermatol 2020;19:1447-55.","DOI":"10.1111\/jocd.13193"},{"key":"31936","doi-asserted-by":"crossref","unstructured":"8. Ebrahim HM, Albalate W. Efficacy of microneedling combined with tacrolimus versus either one alone for vitiligo treatment. J Cosmet Dermatol 2020;19:855-62.","DOI":"10.1111\/jocd.13304"},{"key":"31937","doi-asserted-by":"crossref","unstructured":"9. Ebrahim HM, Elkot R, Albalate W. Combined microneedling with tacrolimus vs tacrolimus monotherapy for vitiligo treatment. J Dermatol Treat 2021;32:999-1004.","DOI":"10.1080\/09546634.2020.1716930"},{"key":"31938","doi-asserted-by":"crossref","unstructured":"10. Esmat SM, Gawdat HI, Hegazy RA, et al. Different methods of enhancing the efficacy of topical tacrolimus in extra-facial vitiligo: A comparative study. J Cosmet Dermatol 2021;20:3545-51.","DOI":"10.1111\/jocd.14024"},{"key":"31939","doi-asserted-by":"crossref","unstructured":"11. Sharma1 S. Evaluation of combination of microneedling with tacrolimus in the Treatment of Stable Vitiligo. Port J Dermatol 2021;79.","DOI":"10.29021\/spdv.79.3.1336"},{"key":"31940","doi-asserted-by":"crossref","unstructured":"12. Joseph-Michel Bailey A, Oi-Yee Li H, Zheng D, et al. Microneedling as an Adjuvant to Local Therapies for Vitiligo: A Systematic Review and Meta-Analysis. Dermatol Surg 2021;47:1314-6.","DOI":"10.1097\/DSS.0000000000003048"},{"key":"31941","doi-asserted-by":"crossref","unstructured":"13. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62:e1-34.","DOI":"10.1016\/j.jclinepi.2009.06.006"},{"key":"31942","doi-asserted-by":"crossref","unstructured":"14. Sterne JAC, Savovi\u0107 J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898.","DOI":"10.1136\/bmj.l4898"},{"key":"31943","doi-asserted-by":"crossref","unstructured":"15. Korobko IV, Lomonosov KM. A pilot comparative study of topical latanoprost and tacrolimus in combination with narrow-band ultraviolet B phototherapy and microneedling for the treatment of nonsegmental vitiligo. Dermatol Ther 2016;29:437-41.","DOI":"10.1111\/dth.12383"},{"key":"31944","doi-asserted-by":"crossref","unstructured":"16. Mina M, Elgarhy L, Al-Saeid H, Ibrahim Z. Comparison between the efficacy of microneedling combined with 5-fluorouracil vs microneedling with tacrolimus in the treatment of vitiligo. J Cosmet Dermatol 2018;17:744-51.","DOI":"10.1111\/jocd.12440"},{"key":"31945","doi-asserted-by":"crossref","unstructured":"17. Ibrahim ZA, Hassan GF, Elgendy HY, Al-Shenawy HA. Evaluation of the efficacy of transdermal drug delivery of calcipotriol plus betamethasone versus tacrolimus in the treatment of vitiligo. J Cosmet Dermatol 2019;18:581-8.","DOI":"10.1111\/jocd.12704"},{"key":"31946","doi-asserted-by":"crossref","unstructured":"18. Fai D, Cassano N, Vena GA. Narrow-band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients. J Eur Acad Dermatol Venereol 2007;21:916-20.","DOI":"10.1111\/j.1468-3083.2006.02101.x"},{"key":"31947","doi-asserted-by":"crossref","unstructured":"19. Nordal EJ, Guleng GE, R\u00f6nnevig JR. Treatment of vitiligo with narrowband-UVB (TL01) combined with tacrolimus ointment (0.1%) vs. placebo ointment, a randomized right\/left double-blind comparative study. J Eur Acad Dermatol Venereol 2011;25:1440-3.","DOI":"10.1111\/j.1468-3083.2011.04002.x"},{"key":"31948","unstructured":"20. Bilal A, Shiakh ZI, Khan S, et al. Efficacy of 0.1% topical tacrolimus with narrow band ultraviolet B phototherapy versus narrow band ultraviolet B phototherapy in vitiligo. J Pak Assoc Dermatol 2016;24:327-31."},{"key":"31949","doi-asserted-by":"crossref","unstructured":"21. Attwa EM, Khashaba SA, Ezzat NA. Evaluation of the additional effect of topical 5-fluorouracil to needling in the treatment of localized vitiligo. J Cosmet Dermatol 2020;19:1473-8.","DOI":"10.1111\/jocd.13152"},{"key":"31950","doi-asserted-by":"crossref","unstructured":"22. Ju HJ, Bae JM, Lee RW, et al. Surgical Interventions for Patients With Vitiligo: A Systematic Review and Meta-analysis. JAMA Dermatol 2021;157:307-16.","DOI":"10.1001\/jamadermatol.2020.5756"},{"key":"31951","doi-asserted-by":"crossref","unstructured":"23. Cohen BE, Elbuluk N. Microneedling in skin of color: A review of uses and efficacy. J Am Acad Dermatol 2016;74:348-55.","DOI":"10.1016\/j.jaad.2015.09.024"}],"container-title":["Dermatology Reports"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepress.org\/journals\/dr\/article\/download\/10166\/9576","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepress.org\/journals\/dr\/article\/download\/10166\/9755","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepress.org\/journals\/dr\/article\/download\/10166\/9576","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:39:24Z","timestamp":1759307964000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepress.org\/journals\/dr\/article\/view\/10166"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,21]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,8,22]]}},"URL":"https:\/\/doi.org\/10.4081\/dr.2025.10166","relation":{},"ISSN":["2036-7406","2036-7392"],"issn-type":[{"value":"2036-7406","type":"electronic"},{"value":"2036-7392","type":"print"}],"subject":[],"published":{"date-parts":[[2025,2,21]]}}}