Does it make sense to use a micro needle or derma roller when applying protopic or tacrolimus to the skin?
Study in comments: 70 - 80% repigmentation after 3 months of treatment with derma roller and tacrolimus ointment.
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Interesting article about using a microneedle roller with protopic.
A simple office-based procedure for patients with extensive vitiligo
Link: jaad.org/article/S0190-9622(16)30133-5/fulltext?rss=yes
SURGICAL CHALLENGE
The setup required for various grafting techniques for vitiligo is difficult, and specialized reagents expertise and requisites to perform them. The color matching and repigmentation may not be uniform in all cases, particularly at the margins. To surpass these drawbacks, we tried simple microneedling with a dermaroller device as an inexpensive and quick office-based procedure; it can also be used as transdermal drug delivery modality for large-molecular-weight drugs such as tacrolimus. Microdermaroller-mediated drug delivery can substantially increase effectiveness by passing the stratum corneum barrier and delivering this drug in adequate concentration to the melanocytes and keratinocytes.
SOLUTION
The site was anesthetized with topical lidocaine cream. A Dermaroller with needle length selected according to skin thickness and site of vitiligo (1-2.0 mm) was used to cause pin-point bleeding by rolling it for 15 to 20 minutes with parallel pressure strokes in a crisscross pattern (transverse, longitudinal, and oblique directions). A thin layer of tacrolimus ointment 0.1% was applied during the final pressure strokes. Avoidance of harsh chemical applications, topical antibiotics, and sunscreens was advised to the patient in the immediate postoperative period. There was mild discomfort to the patient for 1 to 2 days. This procedure was done at an interval of 7 to 10 days for a period of 2 to 3 months. Vitiligo Area Scoring Index (VASI) scoring was done before and after procedure.
After approximately 7 to 8 sittings of the procedure over a period of 3 months there was a 70% to 80% repigmentation without scarring. Wood’s lamp examination confirmed the results. Dermaroller with tacrolimus is a simple, effective, office-based procedure with much less downtime that can be used for patients with extensive vitiligo.
It does make sense as the penetration of any cream/ preparation in areas where it is needed most will be increased.
I too will consider using it if and when I happen to reach the stage where only the extremities or small areas are left without any repigmentation.
Thanks.
Best wishes and Happy Xmas.
Hi Saurabh,
I am not a doctor, so definitely use caution when using a micro needle roller. I imagine a safe practice will be to wipe down the skin with alcohol first. Using a sterile titanium micro needle roller is recommended.
My interpretation of why using a micro needle roller works is because an ointment like protopic (tacrolimus) has difficulty absorbing deep into the skin. I actually read another ineffective study that tried a similar approach, but the difference was with the needle length of only 0.2mm instead of 1mm or 2mm needle lengths used in the study.
So to answer your question, Does using a micro needle roller make sense for the penetration of any cream on the skin? I'm really not sure. However, I do think this technique will increase the potency / effectiveness of skin creams or ointments.
Good source:
http://dermaroller.owndoc.com/
Summary:
...
If you have hypopigmented patches , stamp them every 10–14 days with a 1 mm dermastamp.
If you have a hypopigmented, hardened scar or if it is on an area with thick skin(such as the knees) , use a 1.5 mm dermastamp.
Stamp the hypopigmented patches and also stamp slightly outside of its borders to enable the migration of melanocytes from the surrounding normal skin into the hypo-pigmented areas.
...
DJ,
I used once dermaroller with minoxidil on my scalp for hair regrowth. I also experienced then systemic side effects of minoxidil (heart rate 100 bpm, bloated face) . Perhaps it would be useful in hard-to-treat areas like top of the hands, hovever i thik i developed faster and better methods (my site :http://vitiligopatches.com/)
Although the cream penetration/absorption increases, I think that the principle behind it is not the absorption itself. I believe that dermaroller (specially 1 or 2 mm) can do melanocyte tranfer from the border to the vitiligo patches.
So, like any transplantation, tacrolimus would facilitate the adhesion of the new melanocytes by keeping immune system away.
However, my main concern is if vitiligo is spreading, what might generate new patches. If it's not spreading, it's worth a try.
There is another approach, different from "melanocyte transfer", that may work in hairy areas, but should be done with dermastamp, instead.
With a dermastamp tool, one can "stamp" precisely on the patch only. However, pseudocatalase should be applied in order to take advantage of the better penetration, not tacrolimus. In this case, melanocytes would come from follicles, not from border.
Regards,
Flavio