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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.
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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
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Böhm M, Schunter JA, Fritz K, Salavastru C, Dargatz S, Augustin M, Tanew A. S1-Leitlinie: Diagnostik und Therapie der Vitiligo. J Dtsch Dermatol Ges 2022; 20:365-379. [PMID: 35304960 DOI: 10.1111/ddg.14713_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Markus Böhm
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Jo Ana Schunter
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Klaus Fritz
- Hautarztpraxis und Laserzentrum Landau, Landau, Deutschland
| | - Carmen Salavastru
- Universität Carol Davila, Pädiatrische Dermatologie, Bukarest, Rumänien
| | | | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Adrian Tanew
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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Böhm M, Schunter JA, Fritz K, Salavastru C, Dargatz S, Augustin M, Tanew A. S1 Guideline: Diagnosis and therapy of vitiligo. J Dtsch Dermatol Ges 2022; 20:365-378. [PMID: 35246935 DOI: 10.1111/ddg.14713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 01/01/2023]
Abstract
Vitiligo is a common skin disorder characterized by immune-mediated destruction of melanocytes. Non-segmental vitiligo, the most common clinical subtype, has usually a chronic course and often results in significant psychosocial consequences for the affected patient. Early recognition, awareness of comorbidity, precise assessment of disease extent and activity, evaluation of impairment of quality of life as well as rapid initiation of treatment based on currently available evidence-based therapies are crucial cornerstones in the management of vitiligo. This S1 guideline helps German dermatologists to better diagnose and treat vitiligo.
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Affiliation(s)
- Markus Böhm
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Jo Ana Schunter
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Klaus Fritz
- Dermatology Office and Laser Center Landau, Landau, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Ju HJ, Bae JM, Lee RW, Kim SH, Parsad D, Pourang A, Hamzavi I, Shourick J, Ezzedine K. Surgical Interventions for Patients With Vitiligo: A Systematic Review and Meta-analysis. JAMA Dermatol 2021; 157:307-316. [PMID: 33595599 DOI: 10.1001/jamadermatol.2020.5756] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgical interventions are a key part of the therapeutic arsenal, especially in refractory and stable vitiligo. Comparison of treatment outcomes between the different surgical procedures and their respective adverse effects has not been adequately studied. Objective To investigate the reported treatment response following different surgical modalities in patients with vitiligo. Data Sources A comprehensive search of the MEDLINE, Embase, Web of Science, and Cochrane Library databases from the date of database inception to April 18, 2020, was conducted. The key search terms used were vitiligo, surgery, autologous, transplantation, punch, suction blister, and graft. Study Selection Of 1365 studies initially identified, the full texts of 358 articles were assessed for eligibility. A total of 117 studies were identified in which punch grafting (n = 19), thin skin grafting (n = 10), suction blister grafting (n = 29), noncultured epidermal cell suspension (n = 45), follicular cell suspension (n = 9), and cultured epidermal cell suspension (n = 17) were used. Data Extraction and Synthesis Three reviewers independently extracted data on study design, patients, intervention characteristics, and outcomes. Random effects meta-analyses using generic inverse-variance weighting were performed. Main Outcomes and Measures The primary outcomes were the rates of greater than 90%, 75%, and 50% repigmentation response. These rates were calculated by dividing the number of participants in an individual study who showed the corresponding repigmentation by the total number of participants who completed the study. The secondary outcomes were the factors associated with treatment response to the surgical intervention. Results Among the 117 unique studies and 8776 unique patients included in the analysis, rate of repigmentation of greater than 90% for surgical interventions was 52.69% (95% CI, 46.87%-58.50%) and 45.76% (95% CI, 30.67%-60.85%) for punch grafting, 72.08% (95% CI, 54.26%-89.89%) for thin skin grafting, 61.68% (95% CI, 47.44%-75.92%) for suction blister grafting, 47.51% (95% CI, 37.00%-58.03%) for noncultured epidermal cell suspension, 36.24% (95% CI, 18.92%-53.57%) for noncultured follicular cell suspension, and 56.82% (95% CI, 48.93%-64.71%) for cultured epidermal cell suspension. The rate of repigmentation of greater than 50% after any surgical intervention was 81.01% (95% CI, 78.18%-83.84%). In meta-regression analyses, the treatment response was associated with patient age (estimated slope, -1.1418), subtype of vitiligo (estimated slope, 0.3047), and anatomical sites (estimated slope, -0.4050). Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that surgical intervention can be an effective option for refractory stable vitiligo. An appropriate procedure should be recommended based on patient age, site and size of the lesion, and costs.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Jung Min Bae
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Ro Woo Lee
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Soo Hyung Kim
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigharh, India
| | - Aunna Pourang
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Iltefat Hamzavi
- Vitiligo Unit, Multicultural Dermatology Center, Henry Ford Hospital, Detroit, Michigan
| | - Jason Shourick
- Epidemiology in Dermatology and Evaluation of Therapeutics, Département Infectieux/Immuno/Vaccin, Paris-Est University, Paris Est Créteil University, Créteil, France.,Department of Dermatology, Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris Est Créteil University, Créteil, France
| | - Khaled Ezzedine
- Epidemiology in Dermatology and Evaluation of Therapeutics, Département Infectieux/Immuno/Vaccin, Paris-Est University, Paris Est Créteil University, Créteil, France.,Department of Dermatology, Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris Est Créteil University, Créteil, France
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Ragab M, El Zagh O, Farid C. Transverse Needling After Autologous Mini-Punch Grafts Improves Repigmentation in Stable Non-Segmental Vitiligo. Clin Cosmet Investig Dermatol 2021; 14:827-835. [PMID: 34262320 PMCID: PMC8275096 DOI: 10.2147/ccid.s315407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
Background Repigmentation remains the primary target in vitiligo treatment. Melanocyte transfer procedures are often required for repigmenting stable, resistant vitiligo lesions necessitating procedural optimization and comparative evaluation. In the current study, we aimed to assess the additive value of weekly transverse needling sessions after mini-punch grafting for repigmenting stable non-segmental vitiligo lesions versus either procedure alone. Methods Eighty lesions, included in 20 stable non-segmental vitiligo patients, were randomly allocated to each of the three treatment groups (line-1, mini-punch grafting; line-2, needling; and line-3, combined grafting and needling) and to a fourth control group receiving non-procedural treatment (line-4). Oral mini-pulse steroids and narrow-band ultraviolet-B sessions were administered to all patients for 3 months before and 6 months after the interventions. The extent of repigmentation was assessed using planimetry. Secondary outcomes were the time to first repigmentation response, cosmetic matching, and patient satisfaction. Blinding and allocation concealment were not feasible owing to the intervention nature and within subject design. Results Mini-punch grafting followed by weekly needling for 6 months achieved the fastest response and highest extent of repigmentation. Mini-punch grafts and transverse needling alone provided better results than the control group. No steroid-associated side effects were reported. Conclusion Weekly needling sessions after mini-punch grafting hastened and improved the repigmentation extent of stable, resistant, non-segmental vitiligo lesions and should be considered during treatment planning.
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Affiliation(s)
- Magdy Ragab
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Omneya El Zagh
- Department of Dermatology, Venereology and Andrology, Ministry of Health Hospitals, Alexandria, Egypt
| | - Carmen Farid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Dellatorre G, Antelo DAP, Bedrikow RB, Cestari TF, Follador I, Ramos DG, Silva de Castro CC. Consensus on the treatment of vitiligo - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:70-82. [PMID: 33153826 PMCID: PMC7772607 DOI: 10.1016/j.abd.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.
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Affiliation(s)
- Gerson Dellatorre
- Department of Dermatology, Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil
| | | | | | - Tania Ferreira Cestari
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Daniel Gontijo Ramos
- Department of Dermatology, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Caio Cesar Silva de Castro
- Department of Dermatology, Faculty of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
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Karagaiah P, Valle Y, Sigova J, Zerbinati N, Vojvodic P, Parsad D, Schwartz RA, Grabbe S, Goldust M, Lotti T. Emerging drugs for the treatment of vitiligo. Expert Opin Emerg Drugs 2020; 25:7-24. [PMID: 31958256 DOI: 10.1080/14728214.2020.1712358] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Vitiligo is a relatively common autoimmune depigmenting disorder of the skin. There has been a great advance in understanding the pathological basis, which has led to the development and utilization of various new molecules in treating vitiligo. This review aims at a comprehensively describing the treatments available and the emerging treatment aspects and the scope for future developments.Areas covered: This study comprehensively summarizes the current concepts in the pathogenesis of vitiligo with special focus on the cytokine and signaling pathways, which are the targets for newer drugs. JAK kinase signaling pathways and the cytokines involved are the focus of vitiligo treatment in current research, followed by antioxidant mechanisms and repigmenting mechanisms. Topical immunosuppressants may be an alternative to steroids in localized vitiligo. Newer repigmenting agents like basic fibroblast growth factors, afamelanotide have been included and a special emphasis is laid on the upcoming targeted immunotherapy.Expert opinion: The treatment of vitiligo needs to be multimodal with emphasis on targeting different limbs of the pathogenesis. Topical and oral JAK inhibitors are the most promising new class of drugs currently available for treating vitiligo and acts best in conjunction with NB-UVB.
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Affiliation(s)
- Priyanka Karagaiah
- Department of Dermatology, Bangalore Medical College and Research Institute, Bangalore, India
| | - Yan Valle
- Vitiligo Research Foundation, New York, NY, USA
| | - Julia Sigova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Nicola Zerbinati
- Universita degli Studi dell'Insubria Dipartimento di Scienze Chirurgiche e Morfologiche, Varese, Italy
| | - Petar Vojvodic
- Clinic for Mental Disorders "Dr Laza Lazarevic", Belgrade, Serbia
| | | | | | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- University of Rome Guglielmo Marconi, Rome, Italy, Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Torello Lotti
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
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Thakur V, Kumar S, Kumaran MS, Kaushik H, Srivastava N, Parsad D. Efficacy of Transplantation of Combination of Noncultured Dermal and Epidermal Cell Suspension vs Epidermal Cell Suspension Alone in Vitiligo: A Randomized Clinical Trial. JAMA Dermatol 2019; 155:204-210. [PMID: 30601885 DOI: 10.1001/jamadermatol.2018.4919] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgical interventions, notably noncultured epidermal suspension (NCES), are the next line of treatment in patients with vitiligo who fail to respond to medical therapy. Noncultured epidermal suspension is usually performed in patients with vitiligo with duration of clinical stability (DS) of 12 months or longer because DS is a vital parameter in determining outcome of NCES. In this pilot study, we planned to assess the efficacy of a novel combination of noncultured epidermal cell suspension and noncultured dermal cell suspension (NCES and NDCS) in patients with vitiligo with shorter DS (3-6 months). Objective To compare the efficacy of transplantation of NCES and NDCS vs NCES alone in patients with vitiligo with DS of 3 to 6 months. Design, Setting, and Participants A single-center randomized clinical trial including 40 patients with focal, segmental, or generalized vitiligo with DS of 3 to 6 months or more than 12 months was carried out. Based on DS, 2 groups including 20 patients each were recruited (DS in group 1, 3 to 6 months; DS in group 2, more than 12 months). Each group was further randomized into 2 subgroups, A and B. Intervention Patients in subgroups 1A and 2A underwent NCES alone, whereas patients in subgroups 1B and 2B underwent NCES and NDCS. Main Outcomes and Measures Extent of repigmentation, color match, and pattern of repigmentation at 24 weeks. Results Of the 40 study participants, mean (SD) age was 24.9 (4.0) years and 24 (60%) were women; in group 1 with DS for 3 to 6 months, more than 75% repigmentation at 24 weeks was observed in all 10 patients in subgroup 1B (NCES and NDCS) compared with 3 of 10 patients in subgroup 1A (NCES) (100% vs 30%, P = .003). In group 2 (DS > 12 months), the same was observed in 6 of 10 patients in subgroup 2A and 7 of 10 patients in subgroup 2B (NCES) (60% vs 70%, P > .99). The 2 groups and subgroups did not show any significant differences with respect to color matching and pattern of repigmentation. Conclusions and Relevance Combination of NCES and NDCS resulted in excellent response in patients with vitiligo with shorter duration of clinical stability compared with NCES alone. This combination may be used early in the course of stable vitiligo without waiting for a period of 12 months or more since last clinical activity. Trial Registration ClinicalTrials.gov identifier: NCT03013049.
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Affiliation(s)
- Vishal Thakur
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheetanshu Kumar
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Kaushik
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niharika Srivastava
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bae JM, Lee JH, Kwon HS, Kim J, Kim DS. Motorized 0.8-mm micropunch grafting for refractory vitiligo: A retrospective study of 230 cases. J Am Acad Dermatol 2018; 79:720-727.e1. [DOI: 10.1016/j.jaad.2018.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022]
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Dai NT, Chang HI, Wang YW, Fu KY, Huang TC, Huang NC, Li JK, Hsieh PS, Dai LG, Hsu CK, Maitz PK. Restoration of skin pigmentation after deep partial or full-thickness burn injury. Adv Drug Deliv Rev 2018; 123:155-164. [PMID: 29079536 DOI: 10.1016/j.addr.2017.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/28/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
Significant skin pigmentation changes occur when patients suffer deep burn injuries. These pigmentation disorders may cause not only cosmetic and psychological issues, but more importantly it increases the risk of skin cancer or photoaging. Severe burns significantly effect on the process of repigmentation as the pigmentation is tightly regulated by cell proliferation and differentiation of melanocytes and melanocyte stem cells which are housing in the epidermis and hair follicles of the skin. In the present review, we discuss the possible mechanisms to replenish the melanocytes from the healthy epidermis and hair follicles surrounding burn wounds. The molecular mechanisms of skin repigmentation following healing of burn injuries includes the differentiation of melanoblasts into melanocytes, the distribution and responses of melanocytes and melanocyte stem cells after burn injury, and the regulation of melanin production. We also reviewed advanced therapeutic strategies to treat pigmentation disorders, such as convectional surgery, laser, UV treatment and emerging concepts in skin tissue-engineering.
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Noncultured Epidermal Cell Suspension, in Combination With Carbon Dioxide Laser, Improves Punch Grafting Complications. Dermatol Surg 2017; 43:1100-1103. [PMID: 28738400 DOI: 10.1097/dss.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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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.
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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
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Abstract
The quest for skin expansion is not restricted to cover a large area alone, but to produce acceptable uniform surfaces, robust engraftment to withstand mechanical shear and infection, with a minimal donor morbidity. Ease of the technique, shorter healing period and reproducible results are essential parameters to adopt novel techniques. Significant advances seen in four fronts of autologous grafting are: (1) Dermal-epidermal graft expansion techniques, (2) epidermal graft harvests technique, (3) melanocyte-rich basal cell therapy for vitiligo and (4) robust and faster autologous cell cultures. Meek's original concept that the sum of perimeter of smaller grafts is larger than the harvested graft, and smaller the graft size, the greater is the potential for regeneration is witnessed in newer modification. Further, as graft size becomes smaller or minced, these micrografts can survive on the wound bed exudate irrespective of their dermal orientation. Expansion produced by 4 mm × 4 mm sized Meek micrografts is 10-folds, similarly 0.8 mm × 0.8 mm size micrografts produce 100-fold expansion, which becomes 700-fold with pixel grafts of 0.3 mm × 0.3 mm size. Fractional skin harvest is another new technique with 700 μ size full thickness graft. These provide instant autologous non-cultured graft to cover extensive areas with similar quality of engraftment surface as split skin grafts. Newer tools for epidermal blister graft harvest quickly, with uniform size to produce 7-fold expansions with reproducible results. In addition, donor area heals faster with minimal scar. Melanocyte-rich cell suspension is utilised in vitiligo surgery tapping the potential of hair root melanocytes. Further advances in the cell culture to reduce the cultivation time and provide stronger epidermal sheets with dermal carrier are seen in trials.
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Affiliation(s)
- Dinesh Kadam
- Department of Plastic and Reconstructive Surgery, A.J. Institute of Medical Sciences and A.J. Hospital and Research Centre, Mangalore, Karnataka, India
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14
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Vitiligo: Pathogenesis, clinical variants and treatment approaches. Autoimmun Rev 2016; 15:335-43. [DOI: 10.1016/j.autrev.2015.12.006] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/16/2015] [Indexed: 02/08/2023]
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15
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Abstract
The range of treatment options for vitiligo has significantly expanded in the last 10 years and we can offer our patients more effective treatment strategies supported by European guidelines and consensus findings. Topical and UV therapy are-often in combination-the main components of vitiligo treatment. The main outcome parameters include extent and maintenance of gained repigmentation, cessation of spreading, avoidance of side effects and the influence of the treatment on the quality of life. The efficacy of the currently available treatments is often limited. New options include antioxidative or melanocyte-stimulating adjuvant therapies in combination with UV or laser light as well as a topical maintenance treatment to reduce the risk of recurrences. In many cases, psychological support is indicated.
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Affiliation(s)
- M Meurer
- Stiftung zur Förderung der Hochschulmedizin in Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - M Schild
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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Tsuchiyama K, Watabe A, Sadayasu A, Onodera N, Kimura Y, Aiba S. Successful Treatment of Segmental Vitiligo in Children with the Combination of 1-mm Minigrafts and Phototherapy. Dermatology 2016; 232:237-41. [PMID: 26836583 DOI: 10.1159/000442666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Minigrafts using a 1-mm biopsy punch (1-mm minigrafts) are being increasingly used to treat vitiligo. However, there have been few reports of the use of 1-mm minigrafts in pediatric patients. OBJECTIVE To examine the effectiveness of combination therapy with 1-mm minigrafts and phototherapy in children with segmental vitiligo. METHODS Minigrafts were placed in 13 patients aged ≤16 years with segmental vitiligo. Following surgery, 11 patients underwent irradiation with excimer laser light and 2 with narrow-band ultraviolet B light. RESULTS A mean repigmentation of 81.6% was obtained. A particularly high mean repigmentation of 87.9% was seen in patients aged ≤12 years, indicating greater efficacy in these patients than in patients aged ≥13 years (mean, 67.5%). Although a transient cobblestone appearance occurred as an adverse effect, it improved over time. CONCLUSIONS Combined treatment of segmental vitiligo with 1-mm minigrafts and phototherapy can be performed safely and is highly effective in young patients.
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Affiliation(s)
- Kenichiro Tsuchiyama
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Isedeh P, Al Issa A, Lim HW, Mulekar SS, Mulekar SV. Uncommon responses of segmental vitiligo to melanocyte-keratinocyte transplantation procedure. J Cutan Med Surg 2015; 19:177-81. [PMID: 25775633 DOI: 10.2310/7750.2014.14061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with segmental vitiligo (SV), unlike those with nonsegmental vitiligo (NSV), have a more predictable course and are more responsive to surgery. OBJECTIVE To report 10 patients with SV treated with the melanocyte-keratinocyte transplantation procedure (MKTP), who responded with unusual responses not previously reported in the literature. METHODS This is a retrospective, observational study that reports 10 patients with SV who underwent the MKTP between May 2003 and May 2012. RESULTS Two patients had successful repigmentation after split-thickness skin grafting after failure of the MKTP. Two patients developed a hypopigmented ring at a margin of the MKTP-treated area. One patient had complete repigmentation after a second MKTP. Two patients developed koebnerization of the recipient site. Three patients developed new vitiligo patches in previously unaffected areas after the MKTP. CONCLUSIONS Uncommon and even suboptimal responses can occur following the MKTP in SV patients. There is a need for studies to provide better understanding and outcomes for SV patients undergoing the MKTP.
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Affiliation(s)
- Prescilia Isedeh
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MINational Center for Vitiligo & Psoriasis, Riyadh, Saudi ArabiaShetty Nursing Home, Mumbai, India
| | - Ahmed Al Issa
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MINational Center for Vitiligo & Psoriasis, Riyadh, Saudi ArabiaShetty Nursing Home, Mumbai, India
| | - Henry W Lim
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MINational Center for Vitiligo & Psoriasis, Riyadh, Saudi ArabiaShetty Nursing Home, Mumbai, India
| | - Smita S Mulekar
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MINational Center for Vitiligo & Psoriasis, Riyadh, Saudi ArabiaShetty Nursing Home, Mumbai, India
| | - Sanjeev V Mulekar
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MINational Center for Vitiligo & Psoriasis, Riyadh, Saudi ArabiaShetty Nursing Home, Mumbai, India
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Purschke M, Asrani F, Sabir S, Farinelli W, Anderson R. Novel methods for generating fractional epidermal micrografts. Br J Dermatol 2015; 172:1021-8. [DOI: 10.1111/bjd.13468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. Purschke
- Wellman Center for Photomedicine; Massachusetts General Hospital/Harvard Medical School; Boston MA U.S.A
| | - F.A. Asrani
- Wellman Center for Photomedicine; Massachusetts General Hospital/Harvard Medical School; Boston MA U.S.A
| | - S.A. Sabir
- Center for Integration of Medicine and Innovative Technology (CIMIT); Massachusetts General Hospital; Boston MA U.S.A
| | - W.A. Farinelli
- Wellman Center for Photomedicine; Massachusetts General Hospital/Harvard Medical School; Boston MA U.S.A
| | - R.R. Anderson
- Wellman Center for Photomedicine; Massachusetts General Hospital/Harvard Medical School; Boston MA U.S.A
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Kumar R, Parsad D, Singh C, Yadav S. Four compartment method: a simplified and cost-effective method of noncultured epidermal cell suspension for the treatment of vitiligo. Br J Dermatol 2014; 170:581-5. [PMID: 24641482 DOI: 10.1111/bjd.12725] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite continued progress towards an elucidation of pathogenetic pathways in vitiligo, a definitive cure remains elusive. Noncultured epidermal cell suspension (NCECS) is emerging as the treatment of choice for surgical management of both stable and segmental vitiligo. NCECS is very effective in repigmenting stable vitiligo, but the technique requires an expert and the support of a laboratory facility. OBJECTIVES To investigate a simplified and more cost-effective method for NCECS. METHODS We simplified the conventional NCECS method and made it more cost-effective and simple enough to be performed in the clinic without laboratory equipment. We named this the four compartment (FC) method. Six patients with vitiligo were treated with this FC method. RESULTS The FC method for NCECS is highly cost-effective and simple. Six patients with vitiligo were treated and the results showed marked to complete repigmentation in four patients and > 50% repigmentation in two patients in 3 months. CONCLUSIONS The FC method is a cost-effective and simple procedure to prepare epidermal cell suspensions. In this modified method we showed that there is no need for pipette, tips, centrifuge tube and most importantly a centrifuge machine or any other expensive laboratory equipment.
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Affiliation(s)
- R Kumar
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Abstract
Grafting procedures in vitiligo have become quite popular over the last one or two decades especially in India. Starting with the simplest punch grafting we have now a multitude of different grafting techniques available in vitiligo. All of these grafting procedures are associated with certain complications. In addition there are certain factors and surgical pearls that can go a long way in improving the cosmetic results achieved with any of these grafting techniques. This paper will try to address these specific factors and complications associated with these grafting techniques and the ways and means to avoid them.
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Affiliation(s)
- Imran Majid
- Department of Dermatology, Government Medical College, CUTIS Skin and Laser Institute, Srinagar, Kashmir, India
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Allam M, Riad H. Concise review of recent studies in vitiligo. Qatar Med J 2013; 2013:1-19. [PMID: 25003059 PMCID: PMC4080492 DOI: 10.5339/qmj.2013.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 10/20/2013] [Indexed: 12/12/2022] Open
Abstract
Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. Etiological hypotheses of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress and newer theories of melanocytorrhagy and decreased melanocytes survival. There are several types of vitiligo which are usually diagnosed clinically and by using a Wood's lamp; also vitiligo may be associated with autoimmune diseases, audiological and ophthalmological findings or it can be a part of polyendocrinopathy syndromes. Several interventions are available for the treatment for vitiligo to stop disease progression and/or to attain repigmentation or even depigmentation. In this article, we will present an overall view of current standing of vitiligo research work especially in the etiological factors most notably the genetic components, also, types and associations and various and newer treatment modalities.
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Affiliation(s)
- Mohamed Allam
- Dermatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Riad
- Dermatology Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
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Mulekar S, Isedeh P. Surgical interventions for vitiligo: an evidence-based review. Br J Dermatol 2013; 169 Suppl 3:57-66. [PMID: 24098901 DOI: 10.1111/bjd.12532] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S.V. Mulekar
- National Center for Vitiligo; Psoriasis PO Box 300320 Riyadh 11372 Saudi Arabia
- Wimpole Aesthetic Centre; 48 Wimpole Street London W1G 8SF U.K
| | - P. Isedeh
- Multicultural Dermatology Center; Department of Dermatology; Henry Ford Hospital; 3031 West Grand Blvd., Suite 800 Detroit MI 48202 U.S.A
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Sharma S, Garg VK, Sarkar R, Relhan V. Comparative Study of Flip-top Transplantation and Punch Grafting in Stable Vitiligo. Dermatol Surg 2013; 39:1376-84. [DOI: 10.1111/dsu.12263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Stability is taken as the most important parameter before opting for any transplantation technique to treat vitiligo. But, simultaneous donor site repigmentation and depigmentation of grafts at the recipient site has been noted. Similarly donor site depigmentation with complete repigmentation of the recipient area with pigment growing out from each graft has been observed. Successful repigmentation after regrafting in previous punch failure cases has also been reported. Koebner's phenomenon from history (Kp-h) and test grafting were the only available indicators to assess stability. It is quite ironic to note that even after four decades of experience in vitiligo surgery, there seems to be little consensus among workers regarding the optimal required period of stability. Moreover, the exact concept of stability in vitiligo is itself still not transparent and defined beyond doubt Overdependence on KpH or TG may be sometimes misleading in vitiligo. These two reveal the apparent clinical stability only and that may not be the true reflection of stability status of the disease at the molecular level. Antimelanocyte cytotoxic reactivity was observed among CD8+ TCC isolated from perilesional biopsies of patients with vitiligo. An attempt should be made to clearly fathom and define stability, not merely only on clinical ground but along with electron microscopy and histoenzymological analysis of the perilesional and nonlesional skin of vitiligo patients. Probably some growth factors which are responsible for both mitogenic and melanogenic stimulation of melanocytes should also be taken into account. Some serological test(s) could guide us to measure these growth factors.
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Affiliation(s)
- Koushik Lahiri
- From the Pigmentary Disorder Unit, Rita Skin Foundation, GD 381 Sector III, Salt Lake, Kolkata, India
| | - Subrata Malakar
- From the Pigmentary Disorder Unit, Rita Skin Foundation, GD 381 Sector III, Salt Lake, Kolkata, India
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Vitiligo: a comprehensive overview Part II: treatment options and approach to treatment. J Am Acad Dermatol 2011; 65:493-514. [PMID: 21839316 DOI: 10.1016/j.jaad.2010.10.043] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/17/2010] [Accepted: 10/01/2010] [Indexed: 02/04/2023]
Abstract
Vitiligo is a common skin disorder that results in depigmentation. With the appropriate management, many patients can minimize disease progression, attain repigmentation, and achieve cosmetically pleasing results. There are numerous medical and surgical treatments aimed at repigmentation; therapies for depigmentation are available for patients with recalcitrant or advanced disease. The use of cosmetics at all stages of treatment may be vital to the patient's quality of life. Understanding all the available options helps choose the appropriate treatment plan and tailor it to your patient. Part II of this two-part series on vitiligo discusses the indications for, evidence behind, and adverse effects associated with many of the therapies used for vitiligo. Both conventional medical and surgical options are discussed in addition to several alternative and promising new therapies.
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Abstract
BACKGROUND Punch instrument is a circular blade that can be used for many diagnostic and therapeutic purposes in different medical and surgical specialties. Punch surgery (or biopsy) is achieved by using this versatile punch blade under local anesthesia. Basic punch surgery is quick and easy to learn. Complications such as bleeding and infection are minimal. Diagnostic punch surgery can obtain a part of or whole skin lesion for histologic examination. In addition to the skin, nail and mucous membrane tissue can be obtained by punch biopsy. Interestingly, punch biopsy can be used as an adjunctive to fine-needle aspiration to establish the diagnosis of tumors of solid organ such as the breast. Diagnostic punch surgery can be modified to overcome certain problems. The split-punch technique helps avoid crushing the tissue punch when trying to divide it for different examinations. The double-trephine punch facilitates obtaining subcutaneous tissue without the need for full elliptical excision. The string-of-beads technique obviates the need for dissection of tissue into pieces. In other nondermatology and dermatology conditions, such as nerve pathology, arteriosclerosis, melanoma mapping, and eyelid tumors, the diagnosis can be enhanced with the use of punch surgery.Therapeutic punch surgery can be used for excision of unwanted lesions such as nevi, as well as pathologic bone and cartilage tissues. Punch grafting is used in vitiligo surgery and hair transplantion. Punch evacuative surgery can help in the evacuation of unwanted tissue or materials such as lipoma, subungual hematoma, scrotal calcinosis, pseudocyst of the auricle, pilar cyst, and others.Reconstructive punch surgery includes correction of ear lobe defects and acne scars. Enhancement of wound healing can be achieved by use of the punch; therefore, it can help nonhealing ulcers.
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Affiliation(s)
- Khalid M AlGhamdi
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia.
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Abstract
Sequential displays of several treatment options for vitiligo have been scanned from the literature, and are presented here. A few of the medical modalities have been resigned to history, whereas others have become customary in clinical practice. There has also been a recent surge of interest in the surgical treatment of this disease. Accordingly, this has been appraised and summarized. Special attention has been given to prevalent medical modalities so that they may be effectively utilized by those currently in practice.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, India.
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Abstract
Vitiligo is a result of disrupted epidermal melanization with an undecided etiology and incompletely understood pathogenesis. Various treatment options have resulted in various degrees of success. Various surgical modalities and transplantation techniques have evolved during the last few decades. Of them, miniature punch grafting (PG) has established its place as the easiest, fastest, and least expensive method. Various aspects of this particular procedure have been discussed here. The historical perspective, the instruments, evolution of mini grafting down the ages, and the methodology, advantages, and disadvantages have been discussed. A detailed discussion on the topic along with a review of relevant literature has been provided in this article.
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Affiliation(s)
- Koushik Lahiri
- Department of Dermatology, Apollo Gleneagles Hospital and Pigmentary Disorder Unit, Rita Skin Foundation, India.
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Lahiri K, Malakar S, Sarma N, Banerjee U. Repigmentation of vitiligo with punch grafting and narrow-band UV-B (311 nm)--a prospective study. Int J Dermatol 2006; 45:649-55. [PMID: 16796620 DOI: 10.1111/j.1365-4632.2005.02697.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Phototherapy is already established as an effective mode of therapy in vitiligo. An evidence-based study was carried out of the effect of narrow-band (311 nm) ultraviolet-B (NB-UV-B) radiation in 66 surgically treated patients with recalcitrant vitiligo in whom autologous mini-punch grafting was deployed. METHODS A total of 2613 grafts were placed over 108 lesions on 17 regions in 66 individuals (39 females and 27 males) with stable, refractory vitiligo. The age range was 21-48 years. Postsurgically, they were exposed to a suberythemal dose of NB-UV-B (311 nm). Different parameters of surgical repigmentation were documented. RESULTS Successful repigmentation was achieved in 57 (86.36%) cases. The appearance of repigmentation (AOR) time in different regions varied between 14 and 32 days, with an overall average of approximately 20.6 days. Maximum pigment spread (MPS) reached 12 mm with an average of 6.5 mm. The relationship between the donor graft area and area of surgical repigmentation was also calculated. Cobblestoning was the most common (31.8%) complication, but improved with time and/or interference. CONCLUSIONS Punch grafting in combination with phototherapy (NB-UV-B, 311 nm) was found to be an easy, safe, inexpensive, and effective method of repigmenting static and stubborn vitiligo. Different facets of punch grafting-induced and phototherapy-aided surgical repigmentation were taken into consideration. The area of repigmentation, MPS, and relationship between the donor graft area and area of surgical repigmentation were documented.
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Affiliation(s)
- Koushik Lahiri
- Pigmentary Disorder Unit, Rita Skin Foundation, Calcutta, India.
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Khpur S, Sharma VK, Yashpal M. Comparison of Minipunch Grafting versus Split-Skin Grafting in Chronic Stable Vitiligo. Dermatol Surg 2006. [DOI: 10.1111/j.1524-4725.2005.31110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Vitiligo of the palm can be resistant to conventional treatments, and grafting is not routinely attempted because of some difficulties. OBJECTIVE To do a autologous minigraft test on a vitiligo patch on the palm using skin of the instep as the donor. METHODS Under local anesthesia, two 2 mm minigrafts were transplanted into the vitiliginous skin of the palm of a 28-year-old female. Psolaren with ultraviolet A therapy followed the surgery for 12 weeks. RESULTS Excellent repigmentation was seen around the grafts at the end of 12 weeks. There were no complications. CONCLUSION The skin of the instep is an ideal donor site for palmar vitiligo.
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Affiliation(s)
- Pramod Kumar
- Department of Dermatology, Kasturba Medical College, Mangalore, India.
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Abstract
BACKGROUND Vitiligo therapy is difficult. Depending on its clinical presentation, unilateral or bilateral vitiligo lesions respond well with different repigmentation rates, according to age, affected anatomic area, extension of lesions, time at onset, timing of depigmentation spread, and other associated factors. When stable and refractory to medical treatment, vitiligo lesions may be treated by implanting pigment cells on depigmented areas. OBJECTIVE To describe the main events of depigmentation and the fundamentals of surgical techniques for repigmenting vitiligo by implanting noncultured cellular or tissue grafts, in vitro cultured epidermis-bearing pigment cells, or melanocyte suspensions. METHODS A description of the available techniques for repigmentation of vitiligo is done, emphasizing the most important details of each procedure to obtain the best repigmentation and minimize side effects. RESULTS With most of these techniques, adequate repigmentation is obtained, although there are limitations when applying some methods to clinical practice. CONCLUSIONS Restoration of pigmentation may be accomplished with all available surgical procedures in most anatomic locations, but they are of little value for acral areas. Unilateral vitiligo responds well in a high proportion of patients, and bilateral disease may also respond when stable. Appropriate patient selection is important to achieve the best results.
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Affiliation(s)
- Rafael Falabella
- Department of Dermatology, Universidad del Valle, Hospital Universitario del Valle, Centro Médico Imbanaco, Carrera 38A, No. 5A-100, Cali, Colombia.
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Malakar S, Lahiri K. Spontaneous repigmentation in vitiligo: why it is important. Int J Dermatol 2005. [DOI: 10.1111/j.1365-4632.2005.02657.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malakar S, Lahiri K. Punch Grafting for Lip Leucoderma. Dermatology 2004; 208:125-8. [PMID: 15057001 DOI: 10.1159/000076485] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2001] [Accepted: 10/09/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lip leucoderma (LL) is a common concern of great psychological scarring. The condition is often resistant to medical management due mainly to the absence of hair follicles. Melanocyte transfer, therefore, by any surgical procedure may repigment this condition. OBJECTIVE To repigment LL by punch graft (PG) and to estimate and evaluate the degree of repigmentation and its complications. METHODS One hundred and eight cases of stable and resistant LL of various causes were studied. They were followed up to a maximum of 5 years. RESULTS Graft take was achieved in 98 cases (91%) whereas all the grafts were rejected in 8 cases of herpes-labialis-induced LL (HlLL). Two cases (1.5%) showed depigmentation of grafts. Cobblestoning was the most common complication and was observed in 32 cases (30%). Complete repigmentation was achieved in 78 cases (72%). CONCLUSION PG is a simple office procedure to treat LL. The procedure should exclude HILL.
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Barman KD, Khaitan BK, Verma KK. A Comparative Study of Punch Grafting Followed by Topical Corticosteroid Versus Punch Grafting Followed by PUVA Therapy in Stable Vitiligo. Dermatol Surg 2004; 30:49-53. [PMID: 14692927 DOI: 10.1111/j.1524-4725.2004.30003.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Punch grafting followed by PUVA is an established therapy for stable vitiligo, but punch grafting followed by topical corticosteroid has never been evaluated. OBJECTIVE The aim of this study was to evaluate the efficacy of topical corticosteroid in perigraft pigmentation and to compare it with perigraft pigmentation after PUVA in patients with stable vitiligo. METHODS Fifty patients with stable vitiligo of various clinical types were subjected to punch grafting. In a randomized case study, these patients were divided into two groups: One group received post punch-grafting PUVA (group I) and the other group post punch-grafting topical application of fluocinolone acetonide 0.1% (group II). During the follow-up period of 6 months, six patients were lost to follow-up, and two patients were excluded from the study; 42 patients were evaluated for pigment spread and side effects. RESULTS In group I, the average pigment spread was 6.38 mm, whereas in group II, it was 6.94 mm, showing a slightly higher pigment spread in group II, which was statistically not significant (P=0.301). There was no difference in response to therapy in patients having segmental vitiligo as compared with nonsegmental vitiligo. Cobblestoning, depigmentation of the grafts, infection, and graft displacement were the important side effects seen in some patients in both the groups. CONCLUSION The study shows that the pigment spread with topical corticosteroid is comparable to that with PUVA. However, the studies with long-term follow-up are required to establish this. The advantages of topical corticosteroid are that its use is easy, less cumbersome, cheaper, and more cost effective than PUVA.
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Affiliation(s)
- Krishna Deb Barman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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40
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A Comparative Study of Punch Grafting Followed by Topical Corticosteroid Versus Punch Grafting Followed by PUVA Therapy in Stable Vitiligo. Dermatol Surg 2004. [DOI: 10.1097/00042728-200401000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Julie V Schaffer
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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Acikel C, Ulkur E, Celikoz B. Carbon dioxide laser resurfacing and thin skin grafting in the treatment of "stable and recalcitrant" vitiligo. Plast Reconstr Surg 2003; 111:1291-8. [PMID: 12621204 DOI: 10.1097/01.prs.0000047023.07901.0a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Various surgical methods have been used in the treatment of small stable vitiliginous areas, but there is no established surgical approach for larger vitiligo areas and therapy-resistant anatomic sites, such as the hands. Two years ago, we successfully treated large burn scar depigmentation areas at different anatomic sites using carbon dioxide laser resurfacing and thin (0.2 to 0.3 mm) skin grafting. The purpose of this study was to investigate the effectiveness of our method in treating large, stable, and recalcitrant vitiligo areas. Thirteen anatomic sites of seven male patients, whose ages ranged from 20 to 22 years, were treated. The locations of the treated areas were as follows: seven areas on the dorsum of the hands, two areas on the forearms, two areas in the pretibial region, one area on the lateral thigh, and one area in the presternal region. The surface area of treated vitiligo sites ranged from 0.5 to 6 percent of total body surface area (mean, 2.5 percent). Skin graft take was excellent in all patients except for one. The follow-up period for these patients ranged from 6 to 18 months, with an average follow-up period of 14 months. Early and complete repigmentation was achieved and the color match was good or excellent in all patients. No depigmentation occurred again in the treated areas or graft donor sites. In conclusion, with careful patient selection and delicate surgical technique, our method was effective in treating large areas of vitiligo over the extremities and dorsum of hands, which were refractory to other therapies and could not be hidden.
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Affiliation(s)
- Cengiz Acikel
- Division of Plastic and Reconstructive Surgery and Burn Unit, Gulhane Military Medical Academy, Haydarpasa Hospital, 81327 Uskudar, Istanbul, Turkey.
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Affiliation(s)
- Andreas Katsambas
- Department of Dermatology, University of Athens, A Sygros Hospital, Athens, Greece.
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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 RESEARCH 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] [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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Modified Technique of Autologous Noncultured Epidermal Cell Transplantation for Repigmenting Vitiligo. Dermatol Surg 2001. [DOI: 10.1097/00042728-200110000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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] [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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Sarkar R, Mehta SD, Kanwar AJ. Repigmentation after autologous miniature punch grafting in segmental vitiligo in North Indian patients. J Dermatol 2001; 28:540-6. [PMID: 11732721 DOI: 10.1111/j.1346-8138.2001.tb00027.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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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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Malakar S, Lahiri K, Malakar RS. How unstable is the concept of stability in surgical repigmentation of vitiligo? Dermatology 2001; 201:182-3. [PMID: 11053932 DOI: 10.1159/000018449] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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