1
|
Wang X, Wu W, Chen J, Li C, Li S. Management of the refractory vitiligo patient: current therapeutic strategies and future options. Front Immunol 2024; 14:1294919. [PMID: 38239366 PMCID: PMC10794984 DOI: 10.3389/fimmu.2023.1294919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024] Open
Abstract
Vitiligo is an autoimmune disease that leads to disfiguring depigmented lesions of skin and mucosa. Although effective treatments are available for vitiligo, there are still some patients with poor responses to conventional treatment. Refractory vitiligo lesions are mostly located on exposed sites such as acral sites and lips, leading to significant life stress. Understanding the causes of refractory vitiligo and developing targeted treatments are essential to enhance vitiligo outcomes. In this review, we summarized recent treatment approaches and some potential methods for refractory vitiligo. Janus kinase inhibitors have shown efficacy in refractory vitiligo. A variety of surgical interventions and fractional carbon dioxide laser have been widely applied to combination therapies. Furthermore, melanocyte regeneration and activation therapies are potentially effective strategies. Patients with refractory vitiligo should be referred to psychological monitoring and interventions to reduce the potential pathogenic effects of chronic stress. Finally, methods for depigmentation and camouflage may be beneficial in achieving uniform skin color and improved quality of life. Our ultimate focus is to provide alternative options for refractory vitiligo and to bring inspiration to future research.
Collapse
Affiliation(s)
| | | | | | | | - Shuli Li
- *Correspondence: Shuli Li, ; Chunying Li,
| |
Collapse
|
2
|
Mokhtar M, El-Ashmawy AA, Mostafa WA, Gamei MM. Clinical and dermoscopic evaluation of follicular unit transplantation vs. Mini-Punch grafting in the repigmentation of resistant and stable vitiligo: A comparative study. J Cosmet Dermatol 2022; 21:5837-5851. [PMID: 35634687 DOI: 10.1111/jocd.15127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/28/2022] [Accepted: 05/24/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Various surgical modalities and transplantation techniques had been evolved for the treatment of recalcitrant stable vitiligo. Each of these techniques has its own limitations and side effects. There are insufficient studies evaluating the efficacy of transplantation of hair follicle (HF) units as a surgical modality for vitiligo treatment in comparison with the classic mini-punch grafting. OBJECTIVES To compare the efficacy and safety of follicular unit transplantation (FUT) with mini-punch grafting (mPG) in cases of resistant and stable vitiligo. METHODS Twenty-five patients with stable vitiligo were included. Treated areas were classified into 2 groups: group I: Areas were treated with the FUT technique and group II: Areas were treated with mPG technique. Treated areas were exposed to narrowband ultraviolet B phototherapy for 6 months. After 3 months, follow-up patients' response was evaluated clinically and by dermoscopy. RESULTS Both techniques showed efficacy in repigmentation of stable vitiligo. Group II showed a statistically significant higher percentage of repigmentation and significant earlier repigmentation than group I. Cobblestone-like appearance was the major complication in group II, while no serious side effect was reported in group I. Leukotrichia was present in 8 patients, and 6 of them showed hair repigmentation evidently in group I. CONCLUSION Both techniques are effective, safe, and inexpensive methods of surgical repigmentation of stable localized/segmental vitiligo. mPG gives earlier and better percent of repigmentation, with higher incidence of cobblestoning. FUT is a good alternative for mPG, especially in hairy areas with better cosmetic outcome and minimal complications.
Collapse
Affiliation(s)
- Mennah Mokhtar
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amal Ahmad El-Ashmawy
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Walid Ahmed Mostafa
- Plastic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Mahmoud Gamei
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
3
|
Song H, Hu Z, Zhang S, Yang L, Liu Y, Wang T. Effectiveness and safety of tofacitinib combined with narrowband ultraviolet B phototherapy for patients with refractory vitiligo in real‐world clinical practice. Dermatol Ther 2022; 35:e15821. [DOI: 10.1111/dth.15821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/23/2022] [Accepted: 09/10/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Hongbin Song
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Zhonghui Hu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Shiyu Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Lu Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Yuehua Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Tao Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| |
Collapse
|
4
|
Feily A, Nilforoushzadeh MA, Parvar SY, Hadibarhaghtalab M, Gilman C, Seifi V, Hesamzadeh D, Arzhangian MH, Ghahartars M, Lange CS, Ramirez-Fort MK. Platelet-rich plasma and follicular transplantation versus follicular transplantation alone in the treatment of refractory vitiligo: a comparative pilot study. Dermatol Ther 2022; 35:e15577. [PMID: 35535631 DOI: 10.1111/dth.15577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Amir Feily
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyedeh Yasamin Parvar
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Student research committee, Shiraz University of medical sciences, Shiraz, Iran
| | - Maryam Hadibarhaghtalab
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Casey Gilman
- Pathology and Physiology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Vahid Seifi
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Jahrom University of medical Sciences, Department of Dermatology, Jahrom, Iran
| | - Daryoush Hesamzadeh
- Jahrom University of medical Sciences, Department of Dermatology, Jahrom, Iran
| | | | - Mahdi Ghahartars
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Christopher S Lange
- Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico
| | - Marigdalia K Ramirez-Fort
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico.,Department of Radiation Oncology, Caribbean Radiation Oncology Center, Bayamon, Puerto Rico
| |
Collapse
|
5
|
Kawakami T. Surgical procedures and innovative approaches for vitiligo regenerative treatment and melanocytorrhagy. J Dermatol 2022; 49:391-401. [PMID: 35178747 DOI: 10.1111/1346-8138.16316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022]
Abstract
Surgical treatments for vitiligo are a safe and effective treatment modality for select patients with vitiligo. Many techniques of vitiligo surgery exist, each with unique advantages and disadvantages. We reviewed the various surgical therapies and innovative approaches for vitiligo regenerative treatment reported in the literature. Surgical therapies can be subdivided into tissue grafting methods and cellular grafting methods. Tissue grafting methods mainly include mini punch grafts, suction blister roof grafts, and hair follicle grafts. Cellular grafting methods include cultured and non-cultured treatments. The efficacy needs to be improved largely due to the poor proliferation and quality of the autologous melanocytes. Rho-associated protein kinase inhibitor enhances primary melanocyte culture proliferation from vitiligo patients to prevent apoptosis. Innovative approaches using stem cell methods could prove invaluable in developing a novel cell therapy for patients suffering from vitiligo. We succeeded in inducing melanin pigmentation in mice skin in vivo using our human induced pluripotent stem cell-derived melanocytes. In addition, we reviewed melanocytorrhagy, detachment and transepidermal loss of melanocytes, and melanocyte-related adhesion molecules. These adhesion molecules include epithelial cadherin, discoidin domain receptor tyrosine kinase 1, glycoprotein non-metastatic melanoma protein B, macrophage migration inhibiting factor, 17β-hydroxysteroid dehydrogenase 1, and E26 transformation-specific 1.
Collapse
Affiliation(s)
- Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| |
Collapse
|
6
|
Jimenez F, Alam M, Vogel JE, Avram M. Hair Transplantation: Basic Overview. J Am Acad Dermatol 2021; 85:803-814. [PMID: 33905785 DOI: 10.1016/j.jaad.2021.03.124] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Modern hair restoration surgery is based on a technique known as follicular unit transplantation in which follicular units (FUs) are the exclusive structures used as hair grafts. In Part 1 of this two-part review, we describe how the techniques employed in hair transplantation have evolved into their present forms. Anatomic concepts of specific relevance for dermatologists are discussed, including the distribution and ex-vivo morphology of scalp FUs. Male androgenetic alopecia and female pattern hair loss are the most common reasons for hair loss consultations with dermatologists and will be the primary focus of this review. However, as not all hair disorders are suitable for transplantation, this review will also describe which scalp conditions are amenable to surgery and which are not. In addition, guidelines are provided to help dermatologists better define good or bad candidates for hair transplantation. Finally, other conditions for which hair transplantation surgery is indicated are reviewed.
Collapse
Affiliation(s)
- Francisco Jimenez
- Mediteknia Dermatology and Hair Transplant Clinic, Universidad Fernando Pessoa Canarias, Gran Canaria, Spain.
| | - Majid Alam
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar, Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - James E Vogel
- Associate Professor of Surgery, Department of Plastic Surgery, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Marc Avram
- Clinical Professor of Dermatology Weill Cornell Medical School; Private practice, New York, NY, USA
| |
Collapse
|
7
|
Bergqvist C, Ezzedine K. Vitiligo: A focus on pathogenesis and its therapeutic implications. J Dermatol 2021; 48:252-270. [DOI: 10.1111/1346-8138.15743] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Christina Bergqvist
- Department of Dermatology AP‐HP Henri Mondor University Hospital UPEC Créteil France
| | - Khaled Ezzedine
- Department of Dermatology AP‐HP Henri Mondor University Hospital UPEC Créteil France
- EA 7379 EpidermE Université Paris‐Est Créteil, UPEC Créteil France
| |
Collapse
|
8
|
Feily A, Firoozifard A, Sokhandani T, Elosegui-Rodriguez P, Perez-Rivera E, Lange CS, Hosseinpoor M, Ramirez-Fort MK. Follicular Transplantation, Microneedling, and Adjuvant Narrow-band Ultraviolet-B Irradiation as Cost-Effective Regimens for Palmar-Plantar Vitiligo: A Pilot Study. Cureus 2020; 12:e7878. [PMID: 32489732 PMCID: PMC7255558 DOI: 10.7759/cureus.7878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Treatment of refractory palmar-plantar vitiligo is particularly challenging because the skin in these regions has a limited supply of follicle-derived melanocytic stem cells. Autologous hair transplantation monotherapy is effective in some forms of vitiligo through the provision of melanocytic stem cells. CO2 laser followed by exposure to light (i.e., sunlight or narrow-band ultraviolet-B [nbUVB]) has independently shown to be an effective treatment strategy. Recently, it was found that the combination of hair transplantation and CO2 laser followed by nbUVB exposure had superior efficacy to either modality as monotherapy. Similar to CO2 laser, microneedling produces skin cell proliferation and releases pro-pigmentary cytokines. Given the important role of the cytokines in vitiliginous skin, microneedling may also be an effective therapeutic modality for refractory vitiligo. Herein, we conducted a pilot study to evaluate the efficacy of hair transplantation and CO2 laser or microneedling followed by nbUVB. Microneedling and fractional CO2 laser in combination with hair transplantation and nbUVB both demonstrated utility in the induction of repigmentation in refractory palmar-plantar vitiligo; however, a larger trial would be needed to determine a difference in treatment efficacy. Nonetheless, microneedling is cost-effective and requires minimal training; therefore, microneedling can be easily incorporated into standard dermatological practice.
Collapse
Affiliation(s)
- Amir Feily
- Dermatology, Jahrom University of Medical Sciences, Jahrom, IRN
| | | | | | | | | | - Christopher S Lange
- Radiation Oncology, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | | | | |
Collapse
|
9
|
Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology 2020; 236:571-592. [DOI: 10.1159/000506103] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5–2% of the population worldwide. The disease is characterized by the selective loss of melanocytes which results in typical nonscaly, chalky-white macules. In recent years, considerable progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Vitiligo is often dismissed as a cosmetic problem, although its effects can be psychologically devastating, often with a considerable burden on daily life. In 2011, an international consensus classified segmental vitiligo separately from all other forms of vitiligo, and the term vitiligo was defined to designate all forms of nonsegmental vitiligo. This review summarizes the current knowledge on vitiligo and attempts to give an overview of the future in vitiligo treatment.
Collapse
|
10
|
Ding X, Zhao M, Li M, Du J. A self-controlled comparative study of mini punch graft versus suction blister epidermal graft in the treatment of stable vitiligo. J DERMATOL TREAT 2019; 32:585-589. [PMID: 31670993 DOI: 10.1080/09546634.2019.1687827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mini punch graft (MPG) and suction blister epidermal graft (SBEG) are both effective for stable vitiligo, but there is a lack of self-controlled comparison between these two procedures. OBJECTIVE To compare the efficacy and safety of MPG and SBEG in stable vitiligo. MATERIALS AND METHODS Twenty-three patients were enrolled in this study. A single white patch from each patient was divided into two halves, one half was treated by MPG, while the other half was treated by SBEG (blister or dermabrasion for recipient site), followed by narrow-band UVB irradiation twice a week for 3 months. The repigmentation rate, relative melanin index (RMI), and relative erythema index (REI) were measured at different time points. RESULTS The repigmentation rate of grafts was 98.7% (312/316) in MPG, 98% (49/50) in SBEG (blister for recipient site) and 99.3% (272/274) in SBEG (dermabrasion for recipient site). The RMI and REI at different time points had no statistical difference between MPG and SBEG. Cobblestone appearance was the predominant complication in SBEG. For MPG, superficial scar occurred in two cases in recipient sites and no obvious side effects in donor sites. CONCLUSIONS MPG is much easier, faster with less side effects in donor site.
Collapse
Affiliation(s)
- Xiaolan Ding
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Mingfu Zhao
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Man Li
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Juan Du
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| |
Collapse
|
11
|
Hirobe T, Enami H. Excellent color-matched repigmentation of human vitiligo can be obtained by mini-punch grafting using a machine in combination with ultraviolet therapy. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2018.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
12
|
Ezz-Eldawla R, Abu El-Hamd M, Saied SM, Hassanien SH. A comparative study between suction blistering graft, mini punch graft, and hair follicle transplant in treatment of patients with stable vitiligo. J DERMATOL TREAT 2018; 30:492-497. [PMID: 30252548 DOI: 10.1080/09546634.2018.1528329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Vitiligo is an acquired disfiguring common depigmented skin disease. Objectives: This study aimed to compare the clinical efficacy and safety of suction blistering graft, mini punch and hair follicle techniques in treatment of patients with stable vitiligo. Methods: Thirty patients with stable vitiligo were included. Patients were divided into 3 groups, in group (A) 10 patient underwent suction blistering technique, in group (B) 10 patients underwent mini punch technique and in group (C) 10 patients underwent hair follicle technique. Then all patients in the three techniques were subjected to narrow-band ultraviolet B (NB-UVB) phototherapy for 3 months. All patients were assessed by determining the percentage of repigmentation and Dermatology Life Quality Index (DLQI) before and 3 months after the operation. Results: The percentage of repigmentation of vitiligo in suction blister technique was significantly higher than both mini punch and hair follicle techniques (p value .001 and .0001 respectively). There was a statistically significant difference between the three techniques regarding DLQI score after operation (p value = .0001). Conclusion: This study concluded that suction blistering technique is more effective and safe than mini punch technique and hair follicle technique in treatment of stable vitiligo.
Collapse
Affiliation(s)
- Reham Ezz-Eldawla
- a Department of Dermatology, Venereology and Andrology, Faculty of Medicine , Sohag University , Sohag , Egypt
| | - Mohammed Abu El-Hamd
- a Department of Dermatology, Venereology and Andrology, Faculty of Medicine , Sohag University , Sohag , Egypt
| | - Samia Mohammed Saied
- b Department of Plastic Surgery, Faculty of Medicine , Sohag University , Sohag , Egypt
| | - Sara Hassan Hassanien
- a Department of Dermatology, Venereology and Andrology, Faculty of Medicine , Sohag University , Sohag , Egypt
| |
Collapse
|
13
|
Lommerts J, Uitentuis S, Bekkenk M, de Rie M, Wolkerstorfer A. The role of phototherapy in the surgical treatment of vitiligo: a systematic review. J Eur Acad Dermatol Venereol 2018; 32:1427-1435. [DOI: 10.1111/jdv.14950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/28/2018] [Indexed: 12/31/2022]
Affiliation(s)
- J.E. Lommerts
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| | - S.E. Uitentuis
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| | - M.W. Bekkenk
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| | - M.A. de Rie
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
- Department of Dermatology; VU Medical Centre; Amsterdam The Netherlands
| | - A. Wolkerstorfer
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| |
Collapse
|
14
|
Gandhi S, Shashikiran AR, Murugesh SB, Kusagur M, Sugareddy. Efficacy of topical 5% fluorouracil needling in vitiligo. Indian J Dermatol Venereol Leprol 2018; 84:203-205. [DOI: 10.4103/ijdvl.ijdvl_386_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
15
|
Fractional CO2 Laser Pretreatment to Autologous Hair Transplantation and Phototherapy Improves Perifollicular Repigmentation in Refractory Vitiligo: A Randomized, Prospective, Half-Lesion, Comparative Study. Dermatol Surg 2017; 42:1082-8. [PMID: 27560291 DOI: 10.1097/dss.0000000000000844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fractional CO2 laser and autologous hair transplantation are independently effective in the treatment of refractory and stable vitiligo. OBJECTIVE The authors' purpose was to evaluate the therapeutic efficacy of fractional CO2 laser pretreatment compared with autologous hair transplantation and phototherapy alone for refractory and stable vitiligo. METHODS A total of 20 patients with refractory and stable vitiligo were enrolled from our clinic. Resistant lesions randomly divided into 2 regions as follows: (1) Part A: fractional CO2 laser pretreatment followed by autologous transplantation and phototherapy, and (2) Part B: autologous transplantation and phototherapy alone. Five days after fractional CO2 laser application to Part A, both treatment regions received a transplant of scalp grafts. On Day 11, the entire lesion was exposed to narrow-band UVB phototherapy, twice a week for 12 weeks. The diameter of perifollicular repigmentation was measured monthly with a caliper. RESULTS Perifollicular repigmentation was detectable surrounding 74% of grafted hair follicles by Month 3. Furthermore, Part A demonstrated a significantly greater diameter of repigmentation with 6.6 ± 5.8 mm in Part A compared with 4.3 ± 1.8 mm in Part B (p = <.001). CONCLUSION In this study, our results demonstrate improved efficacy of autologous hair transplantation and narrow-band UVB with fractional CO2 laser pretreatment in refractory and stable vitiligo.
Collapse
|
16
|
|
17
|
Repigmentation or stimulated skin physiology? Medical needling in combination with non-cultured skin cell transplantation-The way of the melanocyte. Burns 2017; 42:1879-1881. [PMID: 28341092 DOI: 10.1016/j.burns.2016.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 07/13/2016] [Indexed: 11/22/2022]
|
18
|
Mohamed Mohamed EE, Younes AK, Osmand A, Mohamed R, Makki M, Younis M. Punch graft versus follicular hair transplantation in the treatment of stable vitiligo. J COSMET LASER THER 2017; 19:290-293. [PMID: 28272910 DOI: 10.1080/14764172.2017.1303170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the efficacy of follicular hair transplantation and mini punch graft in the treatment of stable vitiligo. METHODS Thirty-two patients with stable vitiligo were included in this comparative study. A single patch from each patient was divided into two halves: one half was treated by punch graft, while the other half was treated by follicular hair transplantation followed by excimer light twice weekly, and the outcome was assessed at 0, 1, 3 and 6 months post operatively by photography and quartile scale. RESULTS At the final visit, the percentage of improvement of vitiligo in punch graft-treated side was significantly higher than that in follicular hair transplantation-treated side (p < 0.05). Also, repigmentation after punch grafting occurred after a mean period of 2.5 ± 0.5 weeks (range, 2-3 weeks), while after follicular hair transplantation, repigmentation occurred after 5.2 ± 1.9 weeks (range, 5-8 weeks) (p < 0.05). Cobblestone appearance was the most common complication after punch graft; it occurred in 29 patients (90%), while no reported side effects occurred after follicular graft technique. CONCLUSION Punch grafting is more effective than follicular grafting in the treatment of stable vitiligo; however, follicular hair transplantation is cosmetically better, so we recommend it in exposed areas as face.
Collapse
Affiliation(s)
| | | | - Ahmed Osmand
- b Plastic Surgery Department , Assiut University , Assiut , Egypt
| | - Refaat Mohamed
- a Department of Dermatology , Al Azhar University (Assiut) , Egypt
| | - Mahmoud Makki
- a Department of Dermatology , Al Azhar University (Assiut) , Egypt
| | - Marwa Younis
- c Dermatology and Andrology Clinic , Government of Health , Assiut , Egypt
| |
Collapse
|
19
|
Komen L, Vrijman C, Prinsen CAC, van der Veen JPW, Luiten RM, Wolkerstorfer A. Optimising size and depth of punch grafts in autologous transplantation of vitiligo and piebaldism: a randomised controlled trial. J DERMATOL TREAT 2016; 28:86-91. [DOI: 10.1080/09546634.2016.1179251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lisa Komen
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte Vrijman
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cecilia A. C. Prinsen
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - J. P. Wietze van der Veen
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Medical Center Haaglanden, Hague, The Netherlands
| | - Rosalie M. Luiten
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Abstract
Vitiligo is an acquired depigmenting disorder that affects 0.5% to 2% of the world population. Three different forms are classified according to the distribution of lesions; namely non-segmental, segmental and mixed vitiligo. Vitiligo is associated with polymorphisms in genes involved in the immune response and in melanogenesis. However, environmental factors are required for the development of manifest disease. In general, the diagnosis is clinical and no laboratory tests or biopsies are required. Metabolic alterations are central to current concepts in pathophysiology. They induce an increased generation of reactive oxygen species and susceptibility to mild exogenous stimuli in the epidermis. This produces a senescent phenotype of skin cells, leads to the release of innate immune molecules, which trigger autoimmunity, and ultimately causes dysfunction and death of melanocytes. Clinical management aims to halt depigmentation, and to either repigment or depigment the skin, depending on the extent of disease. New therapeutic approaches include stimulation of melanocyte differentiation and proliferation through α-melanocyte-stimulating hormone analogues and through epidermal stem cell engineering. Several questions remain unsolved, including the connection between melanocyte depletion and stem cell exhaustion, the underlying degenerative mechanisms and the biological mediators of cell death. Overall, vitiligo is an excellent model for studying degenerative and autoimmune processes and for testing novel approaches in regenerative medicine. For an illustrated summary of this Primer, visit: http://go.nature.com/vIhFSC.
Collapse
Affiliation(s)
- Mauro Picardo
- Cutaneous Physiopathology, San Gallicano Dermatologic Institute, IFO IRCCS, via Elio Chianesi 53, 00144 Rome, Italy
| | - Maria L Dell'Anna
- Cutaneous Physiopathology, San Gallicano Dermatologic Institute, IFO IRCCS, via Elio Chianesi 53, 00144 Rome, Italy
| | - Khaled Ezzedine
- Service de Dermatologie et Dermatologie Pédiatrique, Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de Bordeaux, Bordeaux, France
| | - Iltefat Hamzavi
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital Detroit, Michigan, USA
| | - John E Harris
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, USA
| | | | - Alain Taieb
- Service de Dermatologie et Dermatologie Pédiatrique, Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de Bordeaux, Bordeaux, France
| |
Collapse
|