Syringes versus Chinese cups in harvesting suction-induced blister graft: a randomized split-body study

Microneedle-based interstitial fluid extraction for drug analysis: Advances, challenges, and prospects

Similar to blood, interstitial fluid (ISF) contains exogenous drugs and biomarkers and may therefore substitute blood in drug analysis. However, current ISF extraction techniques require bulky instruments and are both time-consuming and complicated, which has inspired the development of viable alternatives such as those relying on skin or tissue puncturing with microneedles. Currently, microneedles are widely employed for transdermal drug delivery and have been successfully used for ISF extraction by different mechanisms to facilitate subsequent analysis. The integration of microneedles with sensors enables in situ ISF analysis and specific compound monitoring, while the integration of monitoring and delivery functions in wearable devices allows real-time dose modification. Herein, we review the progress in drug analysis based on microneedle-assisted ISF extraction and discuss the related future opportunities and challenges.

Surgical Treatment of Vitiligo

Vitiligo is described as a dermatological condition characterized by pigmentation disorders in both the skin and mucous membranes. Clinically, this disease is characterized by the presence of well-defined white areas of various shapes and sizes, which are a manifestation of a reduced number of melanocytes. Due to the fact that vitiligo can be a significant cosmetic problem for patients, a number of methods are currently available to help fight for a better skin appearance. If all the available non-invasive procedures turn out to be ineffective, surgery can help, which is a very good alternative in the case of difficult-to-treat but stable changes. Both the development of new techniques and modifications to the already available treatment of cell and tissue transplantation give hope to numerous patients around the world. The effectiveness of a particular method is determined by its appropriate selection depending on the lesions undergoing therapy. Each form of surgical intervention has its advantages and disadvantages, which, along with the location or size of the treated hypopigmentation area, should be analyzed by a doctor and discussed with their patient. This article is an overview of the currently available methods of surgical treatment of vitiligo and a comparison of their pros and cons.

Non-cultured epidermal cells suspended in either platelet-rich plasma or ringer lactate for stable vitiligo: A prospective comparative study

BACKGROUND

Noncultured epidermal cell suspension (NCES) transplantation is a commonly used surgical treatment for resistant stable vitiligo. The combination of platelet-rich plasma (PRP) with different therapeutic modalities for vitiligo yielded higher repigmentation response, probably due to platelet-derived growth factors.

AIM

To evaluate the efficacy of PRP-suspended NCES compared to NCES suspended in Ringer's lactate (RL) solution in the treatment of stable vitiligo.

PATIENTS AND METHODS

A prospective comparative study was conducted on 40 patients with stable vitiligo. They were divided into two equal groups: group A (treated with RL-suspended NCES) and group B (treated with PRP-suspended NCES). All patients were followed-up for 6 months for assessment of their therapeutic response regarding clinical outcomes and immunohistochemical expression of HMB-45 in lesional skin.

RESULTS

Patients treated with PRP-suspended NCES showed a significantly higher repigmentation response compared to those treated with RL-suspended NCES at 1, 3, and 6 months after treatment (p = 0.015, 0.023, 0.029, respectively). The expression of HMB-45 significantly increased in both groups after therapy, but without a significant difference between the two groups.

CONCLUSION

The repigmentation response of NCES can be enhanced by suspending the melanocytes in autologous PRP.

Clinicopathological evaluation of the donor area following autologous suction blister epithelial grafting vs Thiersch grafting in vitiligo patients: A preliminary study

Surgical vitiligo treatment is suggested for recalcitrant small stable lesions. One of the limitations of this approach is the presence of large lesions. The donor site should be designed to be hidden without previous or present lesions; this limits donor sites. Aim of the study was to clinically and histopathologically evaluate donor areas 3 months and 1 year after Thiersch grafting (TG) and suction blister epithelial grafting (SBEG). Forty patients with stable vitiligo were equally divided into two groups before TG and SBEG. In each patient, the donor site was clinically and histopathologically evaluated after 3 months and 1 year. After 3 months in Group I, hyperpigmentation, mixed pigmentation with atrophic scarring, hyperpigmentation with hypertrophic scarring, erythema, and tough skin were detected in 10%, 50%, 10%, 10%, and 20% of cases, respectively. The condition improved with time leaving, leaving tough skin in all cases after 1 year. In Group II, hyperpigmentation was observed in all patients after 3 months and disappeared completely after 1 year. Histologically, biopsies taken 3 months after TG, showed increased basal pigmentation with dermal changes mimicking scar tissue in 92.5% of cases. Collagen homogenization of and fragmented elastic tissue were reported in all cases. Biopsies showed the same features after 1 year. In the SBEG group, biopsies revealed only basal hyperpigmentation that disappeared after 1 year in all patients. We concluded that SBEG is a scarless operation and regrafting from the same area can be performed. This is in contrast to TG, which is considered a scarring operation, and wherein the donor site cannot be reused for grafting.

Factors affecting the outcome of the suction blisters using two different harvesting techniques in vitiligo patients

BACKGROUND

Suction blister grafting (SBG) technique has been used for long to treat various skin conditions. Different suction methods have been used such as syringes, Chinese cups, and suction device. There are some limitations of its use as time consumption, failure of induction or incomplete blister formation and pain.

AIM

The aim of this work was to evaluate the outcome of using two different suction techniques, namely the syringes and the Chinese cups in induction of suction blisters. The effect of the device diameter and preheating of the donor area on the suction blister induction time (SBIT) was studied. The effect of saline injection in the blister formation and its completion was also evaluated.

METHODS

The study was a left-right comparative study that included 50 patients with stable nonsegmental vitiligo. They were classified into four groups: Group 1 included 15 patients where different diameters of syringes (1.3, 1.7, and 2 cm) were compared against each other, group 2 included 15 patients where different diameters of cups (2, 3.5, and 5 cm) were compared against each other, group 3 included 20 patients subdivided into two groups; 10 patients each, where the effect of preheating the skin on blister induction was tested with use of cups (3a) and syringes (3b). Lastly, group 4 included randomly chosen 40 incomplete or multilocular blisters where the effect of saline injection on blister completion and coalescence of multilobulation was examined. SBIT was calculated in all patients.

RESULTS

The use of the small diameter syringes or cups gave shorter SBIT; however, the difference, which was significant between all sizes of cups, was significant between the 1.3- and 2-cm-diameter syringes only. Preheating of the donor area shorten SBIT significantly. No complications were reported at the donor site except for transient postinflammatory hyperpigmentation in all patients.

CONCLUSION

The small diameter syringes or cups and preheating of the donor area shorten the SBIT, while intra-blister saline injection increased the blister size and turns the multilocular blisters to unilocular ones.