The Value of Methotrexate in NCES for Stable Vitiligo

The goal of this clinical trial is to learn if adding a six months course of Methotrexate would improve the results of non cultured epidermal suspension (NCES) in adult patients with acral and resistant vitiligo lesions over the elbows and knees. researchers will compare results of NCES in two groups one group will receive Methotrexate for 3 months prior to the procedure and 3 months after the procedure, while the other group will not receive the drug. Patients will receive PUVA hand \& feet 3 times/week for 3 months after NCES during this period they will be followed up monthly to evaluate repigmentation.

* Inclusion criteria: * Patients with non-segmental vitiligo (NSV) with acral or resistant lesions over the elbows and knees, that has not responded to conventional treatment * Stability for ≥ 1 year * Age ≥18 years * Exclusion criteria: * Segmental vitiligo * Active vitiligo; new lesions, expansion of old lesions, confetti like lesions, ill-defined edges or koebnerization in \< 1 year * Age \< 18 years. * Pregnant females. * Patients with hematologic, hepatic, renal disease or chronic infection. * Topical treatment in the past month and systemic treatment in the past 3 months.