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Tsukamoto K, Osada A, Kitamura R, Ohkouchi M, Shimada S, Takayama O. Approaches to repigmentation of vitiligo skin: new treatment with ultrasonic abrasion, seed-grafting and psoralen plus ultraviolet A therapy. Pigment Cell Res 2002; 15:331-4. [PMID: 12213088 DOI: 10.1034/j.1600-0749.2002.02034.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Vitiligo vulgaris is a common disease throughout the world although its pathogenesis is not yet known. The most frequent treatment used for vitiligo is PUVA (psoralen plus ultraviolet A) and topical steroids but against stable refractory vitiligo, various other surgical techniques have been developed such as autografting, epidermal grafting with suction blisters, epithelial sheet grafting, and transplantation of cultured melanocytes. We have discovered a new method using ultrasonic abrasion, seed-grafting and PUVA therapy. The ultrasonic surgical aspirator abrades only the epidermis of recipient sites. This easily and safely removes only the epidermis, even on spotty lesions or intricate regions which are difficult to remove using a conventional motor-driven grinder or liquid nitrogen. Epidermal seed-grafting can cover more area than sheet-grafting, and subsequent PUVA treatment can enlarge the area of pigmentation with coalescence of adjacent grafts. In this article, we provide a general overview of the current surgical therapies including our method for treating stable refractory vitiligo.
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Affiliation(s)
- Katsuhiko Tsukamoto
- Department of Dermatology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan.
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102
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Oshima H, Inoue H, Matsuzaki K, Tanabe M, Kumagai N. Permanent restoration of human skin treated with cultured epithelium grafting--wound healing by stem cell based tissue engineering--. Hum Cell 2002; 15:118-28. [PMID: 12703542 DOI: 10.1111/j.1749-0774.2002.tb00106.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The technique of epidermal cell culture developed by Green and colleagues made a breakthrough in the treatment of massive wounds in vivo with grown cells in vitro. In the past two decades, progress of culture methods and clinical practice have been made and now it is possible to treat extensive skin defect with large amounts of cultured epithelium. Since 1985, we have been successfully used cultured epidermis as autografts for the permanent coverage of full-thickness burn wounds or excised burn scars, giant nevi, tattoos and so on. Furthermore, cultured epidermis has been available as allografts to promote the healing of chronic skin ulcers or deep dermal burn. In this paper we describe our clinical experience of cultured epithelium grafting for the treatment of wounds and predict new trial of wound management and regeneration based on tissue engineering concept.
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Affiliation(s)
- Hideo Oshima
- Department of Plastic & Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
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103
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Abstract
BACKGROUND Surgical techniques have recently been introduced for patients with vitiligo. Randomized controlled trials have not been performed. AIM To compare the efficacy and side-effects of two surgical methods (suction blister vs. thin split-thickness graft technique) for the treatment of vitiligo. METHODS Three suction blisters, approximately 0.8 cm in diameter, made with a special tool attached to a vacuum extractor, which were converted to erosions by removal of the roofs of the bullae, and one round erosion of approximately the same diameter, made using a silver knife, were created. One roof of a blister and two cutaneous thin split-thickness grafts taken from the gluteal region were transferred onto recipient vitiliginous areas; one was left alone. The results were evaluated by one non-blind and two blind observers bimonthly during the 3-month follow-up period. RESULTS Repigmentation rates were 25-65% in the suction blister technique and 90% in the thin split-thickness graft technique (P < 0.001). CONCLUSIONS The thin split-thickness graft technique is superior to the suction blister technique in treating vitiligo.
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Affiliation(s)
- Mustafa Ozdemir
- Departments of Dermatology and Plastic Surgery, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, 80200 Turkey.
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104
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Abstract
Vitiligo is a significant problem in children. Many fail to respond to medical treatment and require melanocyte replenishment with one of the various surgical methods. Epidermal grafting using the tops of suction blisters has been found to be the most effective surgical procedure. However, the results of this procedure have never been delineated separately in adolescents and children. There are certain procedural and outcome differences in epidermal grafting among children and adolescents as compared to adults. We performed epidermal grafting in 15 recalcitrant patches of stable vitiligo in 10 children. Thirteen of 15 patches (86.66%) in 8 of the 10 patients (80%) showed more than 75% pigmentation. The results were much better than the overall response rate of 62% in 142 patients (adults as well as children) found in an earlier study. Literature analysis revealed the same trend in other studies.
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Affiliation(s)
- Somesh Gupta
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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105
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106
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van Geel N, Ongenae K, De Mil M, Naeyaert JM. Modified technique of autologous noncultured epidermal cell transplantation for repigmenting vitiligo: a pilot study. Dermatol Surg 2001; 27:873-6. [PMID: 11722524 DOI: 10.1046/j.1524-4725.2001.01045.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several reports have demonstrated that grafting of autologous melanocytes from normally pigmented donor skin can be used for repigmentation of achromic macules in vitiligo. OBJECTIVE To investigate a modified approach in which noncultured autologous melanocytes and keratinocytes are grafted on superficially laser dermabraded vitiligo lesions in a suspension enriched with hyaluronic acid. METHODS Four patients with stable vitiligo were treated using a noncultured melanocyte-keratinocyte suspension. The cellular suspension was grafted on vitiliginous lesions previously dermabraded with a CO2 laser. To improve the viscosity and fixation of the cellular suspension hyaluronic acid was added. Three weeks after grafting, psoralen plus ultraviolet A (PUVA) or ultraviolet B (UVB) therapy was started. Residual leukodermic areas were subsequently retreated. RESULTS Repigmentation was observed within 2-4 weeks and continued to increase for 3 months after treatment. In all patients, 85-100% repigmentation was achieved. A temporary slight color mismatch was visible in all patients. The most homogeneous repigmentation was obtained 5 months after treatment. CONCLUSION This modified procedure seems to be a simple and promising treatment for larger vitiliginous areas.
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Affiliation(s)
- N van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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107
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Abstract
Segmental vitiligo is rather refractory to medical treatment. The paucity of literature on the results of autologous miniature punch grafting in segmental vitiligo in dark-skinned patients led us to conduct such a study in 15 dark-skinned patients of North Indian origin to observe the repigmentation response to this technique at different sites. The age range was 16-42 years (mean 23.08 years). There were four males and eleven females (M:F ratio being 1:2.75) who had the disease for 3-15 years. After autologous miniature punch grafting, a remarkable repigmentation was obtained in 12 (80%) cases with 90% to 100% improvement. About 40-60% repigmentation was observed within 3-6 months in the majority (66.6%) of cases and near total to total repigmentation was observed within 2 years. The maximum pigment spread was observed over the face (cheeks) and neck, and the minimum pigment spread was observed over the left arm and right upper eyelid. Complications were minimal. The present study demonstrates that autologous miniature punch grafting is a safe and easy technique, that produces good cosmetic results in the unsightly depigmenting lesions of segmental vitiligo, especially on the face and exposed areas, even in dark-skinned races if patients are selected carefully. This can be of great benefit to patients who are psychologically disturbed by their disease.
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Affiliation(s)
- R Sarkar
- Department of Dermatology & Venereology, Government Medical College & Hospital, Chandigarh, India
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108
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Abstract
Although the treatment of vitiligo has improved during the last decade, therapy is still not satisfying for many patients. This is probably due to the fact that the aetiopathogenesis is unknown. Several treatment modalities, such as PUVA, UVB and local corticosteroids are currently used in the treatment of active vitiligo. However, these treatments usually induce incomplete repigmentation. Surgical methods intended to repigment leucoderma are an interesting therapeutic option if patients have stable disease. Two types of surgical techniques are available: tissue grafts and cellular grafts, with in between autologous cultured epithelial grafts. Tissue grafts are full-thickness punch grafts, split-thickness grafts and suction blister grafts. With tissue grafts, only a limited surface area can be treated but with good results in the majority of cases. Cellular grafts include non-cultured keratinocytes/melanocytes and cultured melanocytes. The exact success rate of repigmentation with cellular grafts is still unknown, since only a small number of studies have been published. Starting from autologous cellular suspensions, epithelial grafts of various compositions can be cultured in vitro. They can be used for larger areas. The purpose of this review is to describe the applications of different surgical techniques used to treat recalcitrant vitiligo.
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Affiliation(s)
- N van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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109
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Affiliation(s)
- J R Sardi
- Division of Dermatology, School of Medicine "Luis Razetti," Universidad Central de Venezuela, Caracas, Venezuela
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110
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Oh CK, Cha JH, Lim JY, Jo JH, Kim SJ, Jang HS, Kwon KS. Treatment of vitiligo with suction epidermal grafting by the use of an ultrapulse CO2 laser with a computerized pattern generator. Dermatol Surg 2001; 27:565-8. [PMID: 11442594 DOI: 10.1046/j.1524-4725.2001.00334.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Laser ablation is used to remove the recipient epidermis in the suction epidermal grafting in vitiligo surgery. OBJECTIVE To evaluate the effectiveness and safety of a suction epidermal grafting method after the removal of the epidermis by the use of the Ultrapulse CO2 laser with a computerized pattern generator. METHODS Eleven patients with 34 lesions of refractory stable vitiligo were studied. RESULTS Of the 34 lesion sites, excellent repigmentation was seen in 30 and the other 4 had good repigmentation. No complications occurred. CONCLUSION The Ultrapulse CO2 laser is particularly well suited for deepithelialization in vitiligo surgery.
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Affiliation(s)
- C K Oh
- Department of Dermatology, Pusan National University College of Medicine, 1-10 Ami-dong, Seo-Ku, Pusan 602-739, Korea
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Malakar S, Malakar RS. Surgical pearl: composite film and graft unit for the recipient area dressing after split-thickness skin grafting in vitiligo. J Am Acad Dermatol 2001; 44:856-8. [PMID: 11312436 DOI: 10.1067/mjd.2001.111334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S Malakar
- Duncan Gleneagles Clinic and Research Centre, Calcutta, India
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112
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113
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Yaar M, Gilchrest BA. Vitiligo: the evolution of cultured epidermal autografts and other surgical treatment modalities. Arch Dermatol 2001; 137:348-9. [PMID: 11255337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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114
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Arenberger P, Broz L, Veselý P, Havlícková B, Matousková E. Tissue-engineered skin in the treatment of vitiligo lesions. Folia Biol (Praha) 2001; 46:157-60. [PMID: 10954161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Vitiligo is characterized by the loss of skin pigmentation due to the destruction of melanocytes. Its treatment is usually difficult. For stable cases, melanocyte transplantation is the method of choice. A newly developed treatment with recombined human/porcine skin methodology, permitting easy handling of the graft, is described in the present work. In five vitiligo patients, autologous epidermal cells were obtained from pigmented thin skin biopsies. The cells were cultured on a dried cell-free porcine dermis by the 3T3 feeder layer technique. After 10 days melanocytes were regularly dispersed in confluent keratinocyte cultures. Upside-down delivery of epidermal cells was used. The epidermal layer was directly applied onto a dermabraded vitiligo lesion, with porcine dermis covering the lesion. Pigmentation started to be visible 4-6 weeks after grafting. After using the above described methodology, the pigmentation appeared in the range of 65-80% of the grafted area. Additional UVA irradiation enhanced the treatment success up to 100%. The surgical vitiligo treatment appears to be a reasonable method of choice in stable vitiligo cases of a disease lasting for at least two years, which means for approximately 5% of all vitiligo patients.
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Affiliation(s)
- P Arenberger
- Department of Dermatology, 3rd Medical Faculty, Charles University Hospital, Prague, Czech Republic
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115
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117
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Guerra L, Capurro S, Melchi F, Primavera G, Bondanza S, Cancedda R, Luci A, De Luca M, Pellegrini G. Treatment of "stable" vitiligo by Timedsurgery and transplantation of cultured epidermal autografts. Arch Dermatol 2000; 136:1380-9. [PMID: 11074702 DOI: 10.1001/archderm.136.11.1380] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To optimize melanocyte/keratinocyte co-cultivation and to evaluate the effectiveness of autologous cultured epidermal grafts in the surgical treatment of stable vitiligo. DESIGN After optimization of melanocyte/keratinocyte cultures, achromic lesions were disepithelialized by means of programmed diathermosurgery (Timedsurgery) and covered with autologous epidermal grafts prepared from secondary cultures. Melanocyte content was evaluated by dopa reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system. SETTING A biosafety level 3 cell culture facility and a dermatological department in a hospital. PATIENTS Thirty-two patients carrying different types of vitiligo were admitted to the study and treated with autologous cultured epidermal grafts. Inclusion criteria were (1) failure of at least 2 standard medical approaches; (2) no therapy for at least 12 months; (3) absence of progression of old lesions, absence of appearance of new lesions, and absence of Koebner phenomenon within the past 18 months; and (4) absence of autoimmune disorders. RESULTS One hundred five achromic lesions (a total of 6078.2 cm(2)) were treated. The average percentage of repigmentation, evaluated after 12 to 36 months of follow-up, was 77%. Independent of the type of vitiligo, average percentages of repigmentation of extremities and periorificial sites were 8% (31.8 cm(2) repigmented/420.5 cm(2) transplanted) and 35% (17.6 cm(2) repigmented/50.0 cm(2) transplanted), respectively. Percentages of repigmentation of all other body sites ranged from 88% to 96% (4329.7 cm(2) repigmented/4675.2 cm(2) transplanted). Color matching was good and scar formation was not observed. CONCLUSION Cultured epidermal grafts can be considered a real therapeutic surgical alternative for "stable" but not lip-tip vitiligo.
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Affiliation(s)
- L Guerra
- Laboratory of Tissue Engineering, Istituto Dermopatico dell'Immacolata, Via dei Castelli Romani, 83/85, 00040 Pomezia (Roma), Italy.
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118
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Abstract
BACKGROUND A pilot study was conducted to evaluate the efficacy and safety of pulsed erbium:YAG laser ablation of autologous minipunch grafted sites for the treatment of refractory or stable vitiligo. METHODS Thirteen patients, seven men and six women, aged between 19 and 58 years, with Fitzpatrick skin types ranging from type IV to VI, were grafted. The pulsed erbium: YAG laser was used to create recipient graft sites. RESULTS Repigmentation was observed in 12 out of 13 patients. Failure of grafts to repigment ranged from 3% to 100%. No untoward side-effects of surgery were noted. CONCLUSIONS Using an erbium:YAG laser to create graft recipient sites permits the survival of punch harvested grafts and the spread of pigmentation to the surrounding skin.
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Affiliation(s)
- M Sachdev
- Department of Dermatology, Manipal Hospital, Bangalore, India
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119
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Malakar S, Dhar S. Spontaneous repigmentation of vitiligo patches distant from the autologous skin graft sites: a remote reverse Koebner's phenomenon? Dermatology 2000; 197:274. [PMID: 9867361 DOI: 10.1159/000018013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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121
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Chen YF, Chang JS, Yang PY, Hung CM, Huang MH, Hu DN. Transplant of cultured autologous pure melanocytes after laser-abrasion for the treatment of segmental vitiligo. J Dermatol 2000; 27:434-9. [PMID: 10935339 DOI: 10.1111/j.1346-8138.2000.tb02201.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Segmental vitiligo is a special type of vitiligo with unilateral distribution of lesions and has a stable course. Clinically, many patients with segmental vitiligo have unsatisfactory responses to topical corticosteroid or UV phototherapy. We have developed a technique for the isolation of melanocytes from a small specimen of normally pigmented skin obtained via a suction blister. The melanocytes can be proliferated in culture and then replanted onto laser-abrased vitiliginous areas. We used this procedure to treat 25 patients with segmental vitiligo that were refractory to medical therapy. The repigmented portion of the total treated area amounted to 95-100% in 21 patients and 65 to 94% in 4 patients. The response rate to treatment was 100% in this study. No scarring or other side-effects developed. The results of this study demonstrate that this method is a valuable tool for the treatment of patients with segmental vitiligo.
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Affiliation(s)
- Y F Chen
- Department of Dermatology, Show Chwan Memorial Hospital, Changhua City, Taiwan, R.O.C
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122
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Abstract
BACKGROUND Suction devices for epidermal grafting need a suction pump to provide a negative pressure. The authors have developed a suction device in which a syringe and a manometer are employed to provide a negative pressure. OBJECTIVE The purpose of this study was to evaluate the efficacy of our suction device in vitiligo patients. METHODS The suction device was used to obtain epidermal blisters from the donor site. A CO2 laser was employed to remove the depigmented epidermis. The blister roofs of the donor site were harvested and were placed onto the recipient area. Ten patients with stable vitiligo were treated by epidermal grafting. RESULTS Epidermal blisters were produced by suction in all patients. Also, all 10 patients regained repigmentation. CONCLUSION Our suction blister device is simple and inexpensive to make, and it may become an alternative to the other suction devices.
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Affiliation(s)
- H U Kim
- Department of Dermatology, Chonbuk National University Medical School and Institute for Medical Sciences,Chonju, Korea
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123
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Li CQ, Liu ZR, Shi W. [Autologous epidermal grafting plus sicorten cream in the treatment of vitiligo]. Hunan Yi Ke Da Xue Xue Bao 2000; 25:312, 314. [PMID: 12212184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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124
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Abstract
BACKGROUND Suction blister grafting was performed via a modified simple technique using a 20-mL syringe to create the donor graft and pulsed erbium:YAG laser ablation of the recipient site. METHODS Two patients with stable vitiligo and one with postinflammatory depigmentation were studied. RESULTS The grafts took well in all three patients and pigmentation was retained at 20 weeks. No complications occurred. CONCLUSIONS The erbium:YAG laser is an ideal tool for creating graft recipient sites, given its precision in terms of width and depth of ablation. A 20-mL syringe can be used to create a blister of adequate size.
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Affiliation(s)
- M Sachdev
- Department of Dermatology, Manipal Hospital, Bangalore, India.
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125
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Abstract
BACKGROUND Various modalities are available for surgical management of stable, localized patches of vitiligo, which are resistant to conventional medical treatment. Cutaneous surgeons often struggle to select among various methods of surgical treatment that include camouflage tattooing, melanocyte transplants, excision, and melanocyte culture. The advantages, disadvantages, and limitations of all the available modalities are reviewed. OBJECTIVE The purpose of this review is to find out if any guidelines can be drawn regarding the surgical management of stable vitiligo. METHODS This article is based on a review of the medical literature and the author's personal experience over the last decade. RESULTS It is difficult to draw any fixed guidelines from this review. Treatment must be individualized depending upon the site and the extent of involvement. CONCLUSION Although the retrospective nature of this article limits its validity, discussing the various therapeutic options is of value as continuing medical education. Surgical treatment may be individualized to obtain the best possible cosmetic result.
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Affiliation(s)
- S Mutalik
- Dermatotherapy and Cosmetology Center, Maharashtra Medical Foundation, Pune, India.
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126
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Abstract
BACKGROUND Among various surgical therapies for replenishment of melanocytes in recalcitrant and stable vitiligo, punch skin grafting (PSG) and suction blister epidermal grafting (SBEG) are the simplest ones. Literature is lacking on a comparison of both. OBJECTIVE We compared the results of both techniques in small patches of vitiligo. METHODS Fifty stable vitiligo (focal, segmental, and generalized) patients were selected for study. One patient was lost to follow-up and excluded. PSG was done in 48 patches of 25 patients and SBEG was done in 38 patches of 24 patients. All patients were kept on psoralen ultraviolet-A (PUVA)/psoralen sunrays (PUVASOL). Results were evaluated after a follow-up of 4-7 months. RESULTS Thirty-two (67%) patches of the PSG group and 31 (82%) patches of the SBEG group showed greater than 75% pigmentation. The difference in both groups was not statistically significant. Cobblestone appearance (23%) over the recipient area (RA) and superficial scarring of the donor area (DA) (100%) were seen in PSG. No serious complications were seen in both groups. CONCLUSION Both techniques are simple and effective, however, SBEG gives cosmetically better and rapid results.
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Affiliation(s)
- S Gupta
- Department of Dermatology, Rohtak, Haryana, India
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127
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McGovern TW, Bolognia J, Leffell DJ. Flip-top pigment transplantation: a novel transplantation procedure for the treatment of depigmentation. Arch Dermatol 1999; 135:1305-7. [PMID: 10566827 DOI: 10.1001/archderm.135.11.1305] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- T W McGovern
- Department of Dermatology, Yale University School of Medicine, New Haven, Conn, USA
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128
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Lim JT. Repigmentation of vitiligo with autologous blister-induced epidermal grafts. Ann Acad Med Singap 1999; 28:824-8. [PMID: 10672396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Treatment of vitiligo can sometimes be difficult and disappointing. PUVA treatments give fairly good results. However, acral regions like the hands or feet or areas over bony prominences like the elbow, are resistant to PUVA. Blister-induced epidermal grafts have been used to repigment vitiligo skin. This study was carried out on patients with vitiligo areas unresponsive to either PUVA treatments or who had segmental vitiligo. PUVA treatments were resumed after skin grafting. Twenty-five patients with stable vitiligo were grafted with blister-induced epidermal grafts. Up to 70% of the whole vitiligo areas were grafted in one sitting. A total of 105 grafts were done. In 9 grafts, no repigmentation was seen. The remaining 96 grafts resulted in pigmentation. Twelve had partial and 84 had complete repigmentation. No Koebner phenomenon was noted in both the recipient sites or the donor sites. Blister-induced epidermal graft is an effective alternative to repigment stable vitiligo areas. It is easy to do and results are good. In this study, 96 out of 105 (91%) grafts had repigmentation.
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Affiliation(s)
- J T Lim
- National Skin Centre, Singapore
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129
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130
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Abstract
BACKGROUND Suction blister epidermal grafting is a useful modality of treatment of resistant and stable vitiligo; however, it requires expensive and heavy suction apparatus. This study is an attempt to develop a cheap and small apparatus which can be assembled in the physician's own office. PATIENTS AND METHODS The method was tried in 22 vitiligo/leukoderma patients. The apparatus consisted of a cylindrical funnel connected with a three-way tap, and suction was given by a 50-mL syringe. The pressure inside the suction cup was retained by changing the position of lock of the three-way tap. The pressure was measured by connecting the three-way tap to a vacuum gauge. The apparatus remained adhered to the donor area because of negative pressure. The blister was formed in about 1.5 h. The roof of the blister was grafted onto the dermabraded recipient site. RESULTS The pigmentation was complete in 20 out of 22 patients. There were no complications. CONCLUSIONS The technique is inexpensive and easy and obviates the need of cumbersome and heavy equipment.
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Affiliation(s)
- S Gupta
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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131
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Abstract
Vitiligo has been reported to be a contraindication against reduction mammaplasty. However, this report shows for the first time that reduction mammaplasty may serve as a means to excise breast vitiligo lesions and to repigment the recipient areola by a contralateral areolar full-thickness skin graft onto the deepidermized recipient areola. The repigmented areolar skin remained stable and cosmetically pleasing for over 4 years by now. There was no vitiligo occurring in the incision lines.
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Affiliation(s)
- R E Horch
- Department of Plastic and Hand Surgery, Chirurgische Universitätsklinik Freiburg, Albert-Ludwigs-University, Medical School, Freiburg, Germany
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132
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Abstract
BACKGROUND Previous reports have shown the effectiveness of epidermal grafts for patients with stable vitiligo. OBJECTIVE Our purpose was to evaluate the effectiveness and complications of epidermal grafts in patients with stable and progressive vitiligo and to compare the results in both groups. METHODS Epidermal grafting with suction blisters was performed in 40 patients with vitiligo (26 stable and 14 progressive). The grafted sites and donor sites were examined for repigmentation for longer than 3 months, up to 2.5 years. RESULTS Complete repigmentation was observed in 19 patients with stable (73.1%) and 10 with progressive vitiligo (71.4%). Of the 29 patients who experienced complete repigmentation, we noted recurrences in 2 patients with stable disease (10.5%) and 4 with progressive disease (40%). CONCLUSION Although patients with progressive vitiligo showed more frequent recurrence than those with stable disease, epidermal grafting may be an effective treatment not only for stable vitiligo but also for progressive vitiligo.
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Affiliation(s)
- H Y Kim
- Department of Dermatology, Medical School, Chonbuk National University, South Korea
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133
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Malakar S, Dhar S. Repigmentation of vitiligo patches by transplantation of hair follicles. Int J Dermatol 1999; 38:237-8. [PMID: 10208634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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134
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Abstract
Punch grafting was performed in 15 patients using punches varying in size from 2 to 3 mm in diameter. Silicone gel sheets were used as a post-operative dressing. Removal of the dressings after 7 days revealed no lifting of grafts in 13 patients. A minimally raised surface seen in two patients flattened after 6 to 8 weeks of continuous use of the dressing. At two months of follow-up, no cobblestoning or any other untoward effect was evident. Firm pressure provided by silicone gel sheets probably prevents cobblestoning by counteracting forces which tend to lift the grafts. Additionally, the sheets act as a brace preventing graft dislocation, provide a sterile atmosphere underneath the grafts, facilitate periodic observation due to their transparency, and are easily removed at the time of follow-up.
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Affiliation(s)
- U S Agarwal
- Department of Dermatology, STD, and Leprosy, SMS Medical College, Jaipur, India
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135
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Tang WY, De Han J, Lu NZ, Chan LY, Lo KK. Surgical pearl: fine gauze is a useful carrier for epidermal graft in the treatment of vitiligo by means of the suction blister method. J Am Acad Dermatol 1999; 40:247-9. [PMID: 10025753 DOI: 10.1016/s0190-9622(99)70196-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Conventional treatments of vitiligo include topical steroids and PUVA, which necessitate prolonged application and frequent clinic visits; response to such treatments also varies. During the past few years, we have used autologous suction-blister-derived epidermal grafts in more than 150 patients with stable localized vitiligo who did not respond to topical steroids and PUVA. Up to now results are promising. In this method, spreading of the epidermal graft to its maximum size and its accurate transferral onto the recipient area are important steps. However, the graft produced by this method is so thin and soft that it wrinkles and curls frequently, making spreading and transportation to the recipient site cumbersome. In our experience with more than 700 grafts, we found that the use of plain fine gauze makes harvesting and transportation of donor grafts technically simple and effective.
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Affiliation(s)
- W Y Tang
- Department of Health, the Government of the Hong Kong Special Administrative Region, China
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136
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Schwartzmann-Solon AM, Visconti MA, Castrucci AM. Topical application of a melanotropin analogue to vulgar vitiligo dermo-epidermal minigrafts. Braz J Med Biol Res 1998; 31:1557-64. [PMID: 9951552 DOI: 10.1590/s0100-879x1998001200008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Human subjects with active vulgar vitiligo do not respond well to autologous dermo-epidermal minigrafting. Eighteen subjects were treated with the alpha-melanocyte-stimulating hormone (alpha-MSH) synthetic analogue [Nle4, D-Phe7]-alpha-MSH. The hormone (50 microliters, 0.4 mM) was applied topically to 30-cm2 lesions in which 29-48 minigrafts had been made. The hormone did not improve the success of the minigrafting and no differences were observed in local or distant repigmentation in treated subjects as compared to the placebo group. Aliquots of 24-h urine concentrated by lyophilization irreversibly darkened toad skins, demonstrating the presence of the analogue. This is the first report of the transdermal delivery of a topically applied melanotropin in living human subjects.
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137
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Abstract
OBJECTIVE A systematic review of the effectiveness, safety, and applicability of autologous transplantation methods in vitiligo. DATA SOURCES Computerized searches of bibliographical databases, a complementary manual literature search, and contacts with researchers and pharmaceutical firms. STUDY SELECTION Predefined selection criteria were applied to all studies found. DATA EXTRACTION Two investigators independently assessed the articles for inclusion. When there was a disagreement, a third investigator was consulted. DATA SYNTHESIS Sixty-three studies were found, of which 16 reported on minigrafting, 13 on split-thickness grafting, 15 on grafting of epidermal blisters, 17 on grafting of cultured melanocytes, and 2 on grafting of noncultured epidermal suspension. Of these, 39 patient series were included. The highest mean success rates (87%) were achieved with split-skin grafting (95% confidence interval, 82%-91%), and epidermal blister grafting (87%) (95% confidence interval, 83%-90%). The mean success rate of 5 culturing techniques varied from 13% to 53%. However, in 4 of the 5 culturing methods, fewer than 20 patients were studied. Minigrafting had the highest rates of adverse effects but was the easiest, fastest, and least expensive method. CONCLUSIONS Because no controlled trials were included, treatment recommendations should be formulated with caution. Split-thickness and epidermal blister grafting can be recommended as the most effective and safest techniques. No definite conclusions can be drawn about the effectiveness of culturing techniques because only a small number of patients have been studied. The choice of method also depends on certain disease characteristics and the availability of specialized personnel and equipment.
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Affiliation(s)
- M D Njoo
- Netherlands Institute for Pigmentary Disorders, University of Amsterdam, The Netherlands.
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138
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Abstract
BACKGROUND Vitiligo can be successfully treated with grafts of autologous cultured epidermal cells. OBJECTIVE To evaluate the efficacy of autologous grafting of epidermal cells, cultured by an original method, in the treatment of localized vitiligo refractory to other therapies. METHODS Autologous normally pigmented skin was used to culture keratinocytes and melanocytes on a supporting layer of biomaterial (Laserskin), which was grafted directly onto achromatic skin after de-epithelialization with liquid carbon dioxide. The percentage area of repigmentation was calculated by image analysis. RESULTS Initial repigmentation of the treated areas was observed 1 month after treatment. Repigmentation continued to increase for 3 months after grafting. Follow-up at 3, 6, 12, and 18 months showed almost complete repigmentation in six out of 11 cases. In four other patients, 40-71% of the grafted achromatic area was repigmented. In one patient, repigmentation was impeded by sepsis. CONCLUSIONS The method was found to be effective in the treatment of localized vitiligo refractory to other treatments. The therapeutic procedure was simple, reproducible, and easy to use.
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Affiliation(s)
- L Andreassi
- Department of Dermatology, University of Siena, Italy
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139
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Abstract
Coat colour changes in polar animals are related to seasonal variation in photic inputs. The present work was performed to study the photoresponses of hair follicular melanocytes in human skin. The melanocytes, being photosensitive cells, can function as UV biosensors, since dendrites extend towards the source of UV light. Fifty-one skin biopsies from the margin of vitiligo were subjected to whole skin organ cultures. These were exposed to a pulse of UV light to study hair bulb melanocytes in vitiligo. It is observed that the melanocytes are seen within the anagen matrix. These melanocytes are poorly dendritic in control and dark-incubated cultures. On UV exposure, they become highly dendritic, the dendrites extending towards the hair shaft in 93.5%. They show prominent catechol oxidase and noradrenaline positivity, all features of UV responsiveness. The melanocytes within the hair follicle are not directly exposed to UV light. The melanocyte dendricity and the alignment of dendrites towards the shaft on UV exposure indicate that the columns of the cells in the hair shaft act as an efficient fibre-optic system, transmitting UV light. Morphologically, the keratinocytes in the hair shaft are arranged in compressed linear columns which resemble the coaxial bundles of commercial fibre-optic strands as is observed in plants. Keratinocytes in the inner and outer sheaths do not show this arrangement. Thus the hair follicle functions as a specialised UV receptor in the skin responding to nuances of photic inputs in human skin. This is reflected in coat colour changes in animals exposed to large variations in day-night cycles.
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Affiliation(s)
- B Iyengar
- Institute of Pathology (ICMR), New Delhi, India
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140
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Abstract
Vitiligo often induces severe cosmetic disfigurement in patients. Both nonsurgical (medical) and surgical approaches for repigmenting vitiliginous macules are described (Table 1). Currently PUVA therapy appears to be the best method in providing reasonable hope for achieving repigmentation. Guidelines for both topical and systemic PUVA are available. Furthermore, surgical graft of autologous epidermal sheet or cultured melanocytes (often combined with keratinocyte co-culture) can be introduced to repigment the depigmented areas where PUVA is ineffective. PUVA therapy after autologous skin graft can enhance the repigmenting efficiency. Although PUVA with or without surgical procedure represents a useful tool in vitiligo treatment, we should look for other new treatment modalities based upon better understanding of basic biology of melanin pigmentation and pathophysiology of this disease. A recent development of topical pseudocatalase and calcium application combined with UVB phototherapy may be one of the typical examples in this respect. Many patients are significantly affected psychologically by the disease. Physicians should attempt to assess the degree of psychological impairment caused by vitiligo. Supportive care should always be offered if necessary in order to minimize these problems appropriately. In closing, normal skin of vitiligo patients can be totally depigmented by monobenzyl ether of hydroquinone in order to match the skin color in certain generalized vitiligo patients. There is a recent case report of extensive vitiligo with rapid repigmentation of depigmenting vitiliginous skin within a few weeks after discontinuing successful depigmentation therapy by monobenzyl ether of hydroquinone.
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Affiliation(s)
- K Jimbow
- Department of Dermatology, Sapporo Medical University School of Medicine, Japan
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141
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Abstract
BACKGROUND Vitiligo is a disease of unknown cause, and many medical and surgical therapeutic methods are used to treat it. OBJECTIVE Our purpose was to evaluate the effectiveness of single hair grafting in patients with vitiligo. METHODS Single hairs were grafted into vitiliginous areas of 21 patients. The diameter of the spreading pigmentation was evaluated periodically. RESULTS Perifollicular repigmentation around the grafted hair was observed in 15 patients (71%) within 2 to 8 weeks. The diameter of the spreading pigmentation ranged from 2 to 10 mm during a 12-month follow-up period. In cases of generalized vitiligo, perifollicular pigmentation was seen in one of four patients (25%), whereas it was observed in 14 of 17 patients (82%) with localized/segmental vitiligo. Transformation of depigmented hairs into pigmented ones occurred in five patients. CONCLUSION Single hair grafting appears to be an effective method for treating localized/segmental vitiligo, especially on hairy parts of the skin, including the eyelids and eyebrows, and for small areas of vitiligo.
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Affiliation(s)
- G Y Na
- Department of Dermatology, Fatima Hospital, Taegu, South Korea
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142
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Abstract
The aim of this study was to test the usefulness of a melanocyte-enriched cell suspension for the treatment of leucoderma. After removal of a superficial (4-30 cm2) skin sample, the cells were mechanically separated in a trypsin-EDTA solution, centrifuged and washed in a melanocyte medium. The melanocyte-enriched epidermal cell suspension devoid of stratum corneum and stratum granulosum was then applied to the dermabraded depigmented skin. The 26 patients treated had piebaldism (three), vitiligo vulgaris (17), segmental vitiligo (three), halo naevi (one), naevus depigmentosus (one) and chemical leucoderma (one). In patients with widespread piebaldism we found that by diluting the cell suspension the recipient area could be increased to up to 10 times the size of the donor area with the same good results as without or with less dilution. In patients with vitiligo areas of between 50 and 90 cm2, the recipient areas were increased three- to fivefold in the donor area. Patients with piebaldism, segmental vitiligo and halo naevi healed completely, as did most patients with vitiligo. In naevus depigmentosus no effect was seen. Our new method for treatment of leucoderma has the advantage that cell culture is not needed and that it is more suitable than epidermal sheet grafts when several small areas are to be treated.
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Affiliation(s)
- M J Olsson
- Department of Dermatology, University Hospital, Uppsala, Sweden
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143
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Abstract
A variety of grafting procedures using autologous melanocytes have achieved promising results in the treatment of vitiligo. We here report on the preparation of an adequate graft recipient bed by pulsed Erbium-YAG laser skin ablation. In particular, for irregular lesions on delicate sites, which cannot be approached by utilization of suction blisters or dermabrasion, this technique may offer a distinct advantage.
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Affiliation(s)
- R Kaufmann
- Department of Dermatology, J.W. Goethe University, Frankfurt am Main, Germany
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144
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Kahn AM, Cohen MJ. Repigmentation in vitiligo patients. Melanocyte transfer via ultra-thin grafts. Dermatol Surg 1998; 24:365-7. [PMID: 9537012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several years ago, a successful surgical technique for treating depigmentation resulting from burn injuries was developed. OBJECTIVE The purpose of this study was to investigate results of dermabrasion with melanocyte transplantation using new modifications of the technique in patients with vitiligo. METHODS We performed 17 procedures on 12 patients with stable vitiligo. The epithelium of the vitiliginous areas was removed by dermabrasion. The dermabraded area was then reepithelialized with ultra-thin sheet grafts, which more recently were meshed and partially expanded. RESULTS Good to excellent repigmentation was observed in 88% of the procedures. Scarring did not develop in the repigmented or donor site regions. The final color match has been good to excellent. CONCLUSIONS This technique has proven beneficial in 88% of the procedures on our patients. Both our patients and we feel that this provides a valuable treatment option in patients who have failed medical management.
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Affiliation(s)
- A M Kahn
- Department of Surgery, UCLA Medical Center, USA
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145
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Affiliation(s)
- J S Yang
- Department of Dermatology, College of Medicine, Korea University, Seoul
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146
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Olsson MJ, Juhlin L. Epidermal sheet grafts for repigmentation of vitiligo and piebaldism, with a review of surgical techniques. Acta Derm Venereol 1997; 77:463-6. [PMID: 9394984 DOI: 10.2340/0001555577463466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Thin epidermal sheets, obtained by a high-speed air-driven dermatome, were used to repigment white areas in 19 patients with vitiligo and one boy with piebaldism. In the depigmented skin to be treated the epidermis was removed by a rotating diamond fraise under topical and/or local anaesthesia injections. The method was used on most parts of the body, including the eyelids and genitalia. The maximum total area treated on each occasion was 190 cm2. Excellent results could be obtained if the vitiligo had been stable and had not increased anywhere during the last 2 years. Lack of immobilization could explain a poor result in some areas. The donor area on the buttocks healed quickly without depigmentation. In the transplanted area milia were observed in the first 6 months. No scarring was seen. The technique has a niche in the treatment of depigmented skin, especially in larger areas.
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Affiliation(s)
- M J Olsson
- Department of Dermatology, University Hospital, Uppsala, Sweden
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147
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Affiliation(s)
- R Falabella
- Department of Dermatology, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia
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148
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Abstract
Successful repigmentation was achieved in 6 patients with three types of hypomelanosis (vitiligo, piebaldism, and albinism) by transplantation of fresh, autologous cultured epithelium with melanocytes. A small piece of uninvolved skin was taken for cultivation from a site adjacent to the lesion. Epidermal cells were cultured according to Green's technique. The lesions were abraded superficially and autologous cultured epithelium was applied. The grafts with functional melanocytes took completely and the wounds healed with minimal scarring. Repigmentation was visible within 6 to 8 months. The skin color resembled the surrounding normal skin except in the albinistic patient, in whom the donor skin was taken from a hyperpigmented area. Histochemical examination revealed dopa-positive melanocytes 12 to 17 days after grafting in the basal layer of the epidermis and the dermis. These cells grew in the basal layer of the epidermis and the hair follicles. Melanistic granules were visible in the keratinocytes in 1.5 months. A normal number of dopa-positive melanocytes and melanistic granules were seen in approximately 8 months. Thus, the autologous cultured epithelial grafting procedure is a promising treatment for patients with hypomelanosis.
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Affiliation(s)
- N Kumagai
- Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
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149
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Abstract
BACKGROUND Dermabrasion followed by skin grafting has been used for treatment of depigmentation. The short pulsed carbon dioxide (CO2) laser allows removal of the epidermis but leaves necrosis on the surface of the dermis. OBJECTIVES The purpose of this study was to determine if the thermal necrosis would interfere with the take of skin grafts. METHODS Two vitiliginous areas of skin were de-epithelialized, one by conventional dermabrasion and the other with a pulsed CO2 laser. Each area was biopsied for histologic study and grafted with a split-thickness skin graft. RESULTS Histologic studies of the wounds were compared. The residual tissue destruction on the dermis of each area was quite similar. The skin graft take was excellent in both areas. CONCLUSIONS The short pulsed CO2 laser does not cause sufficient thermal necrosis on the surface of the papillary dermis to interfere with a satisfactory skin graft take.
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Affiliation(s)
- A M Kahn
- Department of Surgery, UCLA Medical Center, USA
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150
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Hann SK, Park YK. Dermabrasion and epithelial sheet grafting. J Am Acad Dermatol 1996; 35:652. [PMID: 8859312 DOI: 10.1016/s0190-9622(96)90711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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