Micropigmentation for acral vitiligo: An open-label pilot study of 12 patients

Background: Micropigmentation is a medical tattooing procedure in which pigments are implanted into the superficial dermis using a manual or electrically driven needle. Objective: We aimed to assess the benefit and risk of micropigmentation in the treatment of acral vitiligo refractory to the conventional treatment. Methods: An open-label study was conducted from December 2018 to March 2019. A total of 12 patients with 20 acral vitiligo lesions were treated with micropigmentation using an electric tattooing machine. The micropigmentation treatment was repeated for a few sessions to achieve optimal pigmentation. Color matching between the lesion and peri-lesional skin was assessed using a 4-point grading scale (poor, fair, good, and excellent). Results: Overall, 85% (17 of 20) showed excellent color matching after a median of 2 (range: 1~5) treatment sessions. The post-treatment color was darker than the surrounding skin immediately after the procedure, but it gradually faded over time. Pain during the procedure was not mild, but local anesthetic injection was not required. Post-treatment erythema and swelling occurred, but they resolved within a few days. No allergic reaction to the pigment or koebnerization of the vitiligo was noted. Conclusion: Micropigmentation could be a promising treatment option for refractory acral vitiligo. A few treatment sessions (i.e., retouch) may be required for desired outcomes. The crucial parts of micropigmentation are pigment selection and implantation depth. It does not require injection of local anesthetics and provides immediate treatment effects after the procedure.