الفهرس 
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Abstract
Regarding the reported complications of IACM and microneedling, they were few and minor if not at all, and all patients tolerated the procedure well. Erythema that occurred in all cases was due to microneedling and disappeared within 24 hours. There was no difference according to complications on both sides. This means that IACM has no side effects. The present study showed better results regarding complications when compared with other studies. It was better than 5- fluorouracil which was studied by Mina et al. (2018) (179) as it causes hyperpigmentation, inflammation, and ulceration, and was better than calcipotriol plus betamethasone that cause exfoliation according to Ibrahim et al. (2019) (180). This indicates that IACM could be considered more safe and tolerable for the treatment of vitiligo than other drugs. from the aforementioned data, it was concluded that using IACM combined with microneedling is safe and effective in the treatment of vitiligo. Vitiligo is an acquired idiopathic disease that appears as skin depigmented patches, The worldwide prevalence of vitiligo reached 0.5% to 2%, and up to 1.22% in Egypt, in fact, skin depigmentation in this disorder occurs due to a loss of melanocytes that are responsible for producing melanin pigment in the skin, hair, mucous membranes, and retina. The aim of the study was to assess the efficacy and safety of irradiated amniotic collagen matrix microneedling in treatment of vitiligo. The amnion is the innermost layer of fetal membranes, which form a sac filled with the amniotic fluid, thus surrounding and protecting the embryo, the amniotic epithelial cells produce numerous cytokines and factors known to promote cell proliferation and differentiation. Specifically, amniotic fluid derived mesenchymal stem cells (AF MSC) produce various cytokines and chemokines, which are known to be important in normal wound healing and cosmetic dermatology, including interleukin (IL)‐8, IL‐6, transforming growth factor (TGF)‐β, tumor necrosis factor (TNF)- α, vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). Microneedling is a simple office procedure that involves creating thousands of microclefts through the epidermis into the papillary dermis, so it enhances penetration of growth factors. This right-left comparative study was carried out on (20) patients presenting with vitiligo. All patients were selected from those attending the Outpatient Clinic of Dermatology and Venereology Department of Tanta University Hospital. Patients received a session of treatment every 2 weeks for 6 months (Total 12 sessions). The aim of this work was to assess the efficacy and safety of irradiated amniotic collagen matrix (IACM) combined with microneedling in treatment of vitiligo. o The present study included 20 patients with bilateral symmetrical non segmental stable vitiligo divided into 2 groups: (right side) group subjected to micro-needling with IACM application. (left side) group subjected to micro-needling only. Both groups subjected to micro-needling which was performed under topical anesthesia. The derma pen was rolled on the skin with one hand while stretching the skin with the other hand. The degree of repigmentation was evaluated: Qualitatively by three physicians committee at the end of follow up period (3 months after the last treatment session). The repigmentation responses were expressed as the following: • No change (0%), • Poor (1 –25%), • Moderate (26–50%), • Good (51 –75%), • Excellent (76–99%), • Complete regimentation (100%). And quantitatively by calculating the percentage area of reduction in the area of vitiligo. The percentage reduction in size was calculated as follows: Percentage reduction= 100 According to results of the equation, repigmentation was evaluated into grades as follow: ([0%-25%] poor response [Grade I], [26%-50%] fair response [Grade II], [51%-75%] good response [Grade III], and [76%-100%] excellent response [Grade IV]). For identification of patient satisfaction with the degree of pigmentation, the patients were asked to rate the result of the procedure at the final visit using the following grades: Not satisfied, mildly satisfied, satisfied and very satisfied. The results of this study showed the following: A total of 20 patients completed this comparative study. There was statistically significant difference before and after treatment in each group and between both groups in which (right side) group showed better improvement than (left side) group. The right side treated with combination of microneedling and IACM showed repigmentation in 90%, while in the left side treated with microneedling only, repigmentation was reported in 55% of treated cases. • According to three physicians committee on right side 10% showed no response, 50% showed poor response, 15% showed moderate response, 10% showed good response, 10% showed excellent response and 5% showed complete response. While on left side 45% showed no response, 35% showed poor response and 20% showed moderate response. There was significant difference between both sides in which better improvement was detected in right side with p value (0.002) • According to VAS score on the right side 55% showed poor improvement, 20% showed fair improvement, 10% showed good improvement, and 15 showed excellent improvement .while on the left side , 80% showed poor improvement, 15% showed fair improvement, 5% showed good improvement, and no patient showed excellent improvement. There was significant difference between both sides in which better improvement was detected in right side with p value (0.007). • According to patients‘ satisfaction on right side lesions 10% were not satisfied, 40% were slightly satisfied, 35% were satisfied, and 15% were very satisfied. While on left side lesions, 50% were not satisfied, 30% were slightly satisfied, 20% were satisfied, and no patient was very satisfied. there was significant difference between the two sides in which better results was detected in right side with p value (0.001). • No statistically significant relation between the degree of improvement and age ,sex, family history, duration of disease, duration of stability, number of sessions, type of vitiligo and pattern of repigmentation .while there was statistically significant relation between the degree of improvement and skin type (p=0.027), patient satisfaction (p=0.001) and site (p=0.039). • Skin biopsies showed improvement in both sides after treatment in which prominent large number of basal melanocytes was detected in the (right side) group, and mild increase in number of basal melanocytes was detected in the (left side) group. Expression of HMB-45 stain revealed moderate (+2 ) to strong (+3) immunostaining in the (right side) , and mild (+1 ) immunostaining in the (left side). • The patients were followed up over a period of 3 months after the last session with no complications or changes were occurred and the results of sessions were maintained.