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Shahbazi A, Zargar SJ, Aghdami N, Habibi M. The story of melanocyte: a long way from bench to bedside. Cell Tissue Bank 2024; 25:143-157. [PMID: 37046149 DOI: 10.1007/s10561-023-10081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/23/2023] [Indexed: 04/14/2023]
Abstract
Skin is composed of major layers, namely a superficial epidermis and a deeper dermis. The color of skin is influenced by a number of pigments, including melanin, which is produced by cells called melanocytes. Most skin disorders are relatively benign, but a few, including melanomas, can be fatal. A number of more noticeable disorders, namely albinism and vitiligo, affect the appearance of the skin and its accessory organs. Vitiligo is associated with significant psycho-social morbidity and a major effect on quality of life. Topical steroids, calcineurin inhibitors, phototherapy and surgery are the most common treatments for melanoma. However, there are many patients who do not respond to any of these modalities. The transplantation of cultured or non-cultured melanocyte is the most important treatment for hypopigmentory disorders. This study aims at reviewing the history of melanocyte cultivation, and evaluating the effectiveness of transplantation of cultured cells. For this purpose, the authors examined the initial process of isolation, characterization, and transplantation of epidermal cells. This review, thus, summarizes the current understanding of the cutaneous pigmentary system from the start of synthesis in the pigment cells, along with the response of repigmentation. During the production of melanin, melanosomes are transferred to neighboring keratinocyte in order to form perinuclear melanin caps. The objective of this review is to analyze the melanocytes transplantation in the last century to date, and explore the methods epidermal cells can increase pigmentation in hypo-pigmented areas in skin disorders. Moreover, the focus is on the story of the melanocyte back to 1950s. In addition, prior systemic therapy was associated with a significant increase, based on combined additional therapy, achieving desired results and improved outcomes. Despite the short study of a long way of melanocyte assessment and following up patient treatment, results of the all reports confirmed the efficacy of the method used in the treatment of stable vitiligo patients, who did not respond to the common algorithms of non-invasive treatments.
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Affiliation(s)
- Atefeh Shahbazi
- Department of Cellular and Molecular Biology, School of Biology, College of Science, University of Tehran, Enghelab Street, PO Box: 14155-6455, Tehran, Iran
- Department of Photo Healing and Regeneration, Medical Laser Research Center, Yara Institute, ACECR, Tehran, Iran
| | - Seyed Jalal Zargar
- Department of Cellular and Molecular Biology, School of Biology, College of Science, University of Tehran, Enghelab Street, PO Box: 14155-6455, Tehran, Iran.
| | - Naser Aghdami
- Department of Photo Healing and Regeneration, Medical Laser Research Center, Yara Institute, ACECR, Tehran, Iran
| | - Masoud Habibi
- Department of Photo Healing and Regeneration, Medical Laser Research Center, Yara Institute, ACECR, Tehran, Iran
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2
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Pundir A. Old Is Gold! Outcome of Mini Punch Grafting Using Cyanoacrylate Glue in Female Genital Vitiligo. Dermatol Surg 2024; 50:314-316. [PMID: 38048179 DOI: 10.1097/dss.0000000000004029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Ankita Pundir
- Department of Dermatology, Venereology and Leprosy, BRD Medical College, Gorakhpur, Uttar Pradesh
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3
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Zhou Y, Gao T, Li C, Jian Z. Q-switched ruby laser for depigmentation: A feasible modality to treat vitiligo universalis in children. Indian J Dermatol Venereol Leprol 2024; 90:115-117. [PMID: 37436020 DOI: 10.25259/ijdvl_36_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/13/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Yuqi Zhou
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tianwen Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chunying Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhe Jian
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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4
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Gupta S, Jangra RS, Khatri M, Gupta S. Ballooned glove for smooth epidermal graft transfer in vitiligo. J Am Acad Dermatol 2024; 90:e7-e8. [PMID: 35307490 DOI: 10.1016/j.jaad.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Sanjeev Gupta
- Department of Dermatology and Venereology, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, New Delhi, India.
| | | | - Meghna Khatri
- Department of Dermatology and Venereology, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, New Delhi, India
| | - Somesh Gupta
- All India Institute of Medical Sciences, New Delhi, India
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5
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Uitentuis SE, Lommerts JE, Willemsen M, Willemsen K, de Rie MA, Luiten RM, Bekkenk MW, Wolkerstorfer A. Addition of cell suspension transplantation to UVB and topical treatment in non-segmental vitiligo: a randomized controlled study. Int J Dermatol 2024; 63:e4-e6. [PMID: 37965775 DOI: 10.1111/ijd.16900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Sanne E Uitentuis
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Janny E Lommerts
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcella Willemsen
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Karina Willemsen
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Menno A de Rie
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Rosalie M Luiten
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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6
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Yousif J, Ceresnie MS, Hamzavi IH, Mohammad TF. Practical guidelines for the treatment of vitiligo with the melanocyte-keratinocyte transplantation procedure. Arch Dermatol Res 2023; 316:10. [PMID: 38038734 DOI: 10.1007/s00403-023-02761-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 08/24/2023] [Accepted: 09/16/2023] [Indexed: 12/02/2023]
Abstract
Vitiligo manifests as depigmented macules and patches on the skin and can significantly impact a patient's quality of life. Despite the availability of several treatment modalities, rates of repigmentation can vary widely among individuals and disease subtypes. For patients with stable vitiligo who have not achieved satisfactory results with medical treatments, the melanocyte-keratinocyte transplantation procedure (MKTP) is a viable option. While variations of this autologous non-cultured cellular grafting procedure are performed by dermatologic surgeons worldwide and has shown good tolerability and effectiveness, it remains under utilized in the United States. We present a comprehensive overview of MKTP, highlighting evidence-based and practical techniques to enhance patient outcomes. By serving as a valuable resource, this review aims to support dermatologic surgeons seeking to incorporate MKTP into their practice and promote awareness regarding its benefits, ultimately fostering a more comprehensive approach to vitiligo care.
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Affiliation(s)
- Jenna Yousif
- Wayne State University School of Medicine, 540 E. Canfield Ave, Detroit, MI, USA
| | - Marissa S Ceresnie
- Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA
| | - Tasneem F Mohammad
- Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA.
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7
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Wu Y, Wang T, Song X, Xu A, Dai Y. Treatment of perioral vitiligo with a combination of upper hair follicle transplantation and the application of a 308 nm excimer laser. Skin Res Technol 2023; 29:e13547. [PMID: 38115595 PMCID: PMC10730977 DOI: 10.1111/srt.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Yi Wu
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
| | - Tao Wang
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
| | - Xiuzu Song
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
| | - Ai'e Xu
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
| | - Yeqin Dai
- Department of DermatologyHangzhou Third People's HospitalHangzhouZhejiang ProvinceChina
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8
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Ashique KT, Jayasree P, Kaliyadan F. A multipurpose handle for vitiligo surgery and beyond. Indian J Dermatol Venereol Leprol 2023; 89:923-924. [PMID: 37609753 DOI: 10.25259/ijdvl_996_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/13/2023] [Indexed: 08/24/2023]
Affiliation(s)
| | - Puravoor Jayasree
- Department of Dermatology, Consultant Dermatologist, Medical Trust Hospital, Cochin, Kerala, India
| | - Feroze Kaliyadan
- Department of Dermatology, Sree Narayana Institute of Medical Sciences, Cochin, Kerala, India
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Souroujon AA, Guttman I, Levin N, Capuano G, Reyes Salcedo CA, García P. Autologous cell transplant as a treatment for stable segmental vitiligo: a systematic review. Int J Dermatol 2023; 62:1324-1331. [PMID: 37715361 DOI: 10.1111/ijd.16844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE This systematic review provides a comprehensive analysis of the efficacy of autologous cell transplant as a therapeutic approach for stable segmental vitiligo. Vitiligo poses significant challenges for healthcare professionals in terms of treatment selection. Autologous cell transplant has emerged as a promising modality for managing vitiligo, with cultured and noncultured transplants being considered when determining the patient's treatment approach. There is little knowledge and literature on the subject, so we analyze the different studies. METHOD Using online medical literature databases and the PRISMA guidelines, six out of 60 articles met the acceptance criteria to be analyzed, emphasizing the lack of current literature on this subject. RESULTS Autologous cell transplant achieves excellent pigmentation rates for many body parts. We found that cultivated cells had better results than noncultivated ones. Both types of treatments could pigment 80% or more where needed. CONCLUSION This review highlights the importance of autologous cell transplant as a new and reliable tool for the treatment of stable segmental vitiligo, cultured transplants being the most effective. By employing autologous cell transplant, the repigmentation rate is notably high and consistently achievable. Although its cost and logistical complexities hinder the current accessibility to this therapy, efforts are being made to enhance its availability, and its scope is expected to expand further. More studies are needed to understand this therapy method in other kinds of vitiligo.
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Refat MA, Strassner JP, Frisoli ML, Rashighi M, Richmond J, Nada E, Saleh R, El-Hamd MA, Goldberg D, Mahmoud BH, Harris JE. Lesional CD8+ T-Cell Number Predicts Surgical Outcomes of Melanocyte-Keratinocyte Transplantation Surgery for Vitiligo. J Invest Dermatol 2023; 143:2275-2282.e6. [PMID: 37478900 DOI: 10.1016/j.jid.2023.03.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 07/23/2023]
Abstract
The melanocyte-keratinocyte transplantation procedure (MKTP) treats stable and recalcitrant vitiligo. Despite careful selection of candidates based on clinical stability, the success of the procedure is unpredictable. The aim of our study was to define the immunological profile of stable vitiligo lesions undergoing MKTP and correlate them with clinical outcomes. We included 20 MKTP candidates with vitiligo and a patient with piebaldism as a control. Prior to MKTP, T-cell subsets and chemokines in the recipient skin were measured by flow cytometry and ELISA. During MKTP, melanocytes in the donor skin were quantified by flow cytometry. After MKTP, patients were followed for 12 months and repigmentation was assessed clinically and by ImageJ analysis of clinical photographs. Baseline immunologic biomarkers, duration of clinical stability, and transplanted melanocyte number were correlated to postsurgical repigmentation scores. CD8+ T cells were elevated in 43% of the clinically stable vitiligo lesions. CD8+ T-cell number negatively correlated with postsurgical repigmentation scores (r = -0.635, P = 0.002). Duration of clinical stability, skin chemokines, and transplanted melanocyte number did not influence postsurgical repigmentation. This study demonstrates that CD8+ T-cell number correlates negatively with success of postsurgical repigmentation and can be a biomarker to identify ideal surgical candidates.
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Affiliation(s)
- Maggi A Refat
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA; Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - James P Strassner
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Michael L Frisoli
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Mehdi Rashighi
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Jillian Richmond
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Essam Nada
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohammed Abu El-Hamd
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Dori Goldberg
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Bassel H Mahmoud
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - John E Harris
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA.
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Rajput L, Kharghoria G, Patel U, Gupta S. Chemically assisted gauze abrasion: An economical and convenient alternative to mechanical dermabrasion in vitiligo surgery. J Am Acad Dermatol 2023; 89:e141-e142. [PMID: 34333077 DOI: 10.1016/j.jaad.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Lavina Rajput
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Geetali Kharghoria
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Utpal Patel
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India.
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Abdel Halim DM, Fekry A, Mogawer RM. The value of adding platelet-rich plasma (PRP) to noncultured epidermal cell suspension (NCECS) in surgical treatment of stable resistant vitiligo: A self-controlled randomised double-blinded study. Australas J Dermatol 2023; 64:359-367. [PMID: 37228170 DOI: 10.1111/ajd.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Noncultured epidermal cell suspension (NCECS) is a commonly used surgical treatment for resistant stable acral vitiligo and vitiligo overlying joints. Platelet-rich plasma (PRP) has been reported to enhance the repigmentation response of different therapeutic modalities for vitiligo, including vitiligo surgery. OBJECTIVE To assess the value of adding of PRP to NCECS in the surgical treatment of acral vitiligo and vitiligo overlying joints. PATIENTS AND METHODS This self-controlled randomised trial included 15 patients with 30 lesions in which NCECS suspended in PRP was performed for one lesion and NCECS in ringer's lactate for another comparable lesion. Following NCECS, patients underwent thrice weekly excimer light sessions for 3 months. After 8 weeks, patients underwent preliminary assessment. By the end of the 3 months, both lesions were compared as regards improvement in surface area and pigmentation. Additionally, physician global assessment was made by a blinded investigator. RESULTS Significant improvement was reported in both lesional extent and pigmentation (after PRP and lactated ringer NCECS) with no statistical difference between them. CONCLUSION Despite previous promising results, suspending NCECS in PRP offered no privilege in surgical treatment of acral vitiligo and vitiligo overlying joints, which are quite resistant to treat. PAN AFRICAN CLINICAL TRIAL REGISTRY ID PACTR202108873035929, Date: 16 August 2021.
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Affiliation(s)
| | - Ahmad Fekry
- Alayyat Central Hospital, National Institute of Health, Cairo, Egypt
| | - Rania M Mogawer
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Kim HJ, Son JH, Bang CH, Lee JH, Park Y, Kim YH. Microcutting technique: A novel grafting method for the treatment of vitiligo. Clin Dermatol 2023; 41:545-546. [PMID: 37643697 DOI: 10.1016/j.clindermatol.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Hyun Jee Kim
- Department of Dermatology, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Republic of Korea
| | - Joon Ho Son
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - YoungMin Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeong Ho Kim
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Ding X, Sun Y, Wang F, Du J. Ultrathin Skin Grafting Versus Suction Blister Epidermal Grafting in the Treatment of Resistant Stable Vitiligo: A Self-Controlled Comparative Study. Dermatol Surg 2023; 49:659-663. [PMID: 37000977 DOI: 10.1097/dss.0000000000003780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
BACKGROUND Surgical therapies are effective methods to treat resistant stable vitiligo, with each method having advantages and disadvantages. OBJECTIVE This study aimed to compare the efficacy and safety of ultrathin skin grafting (UTSG) and suction blister epidermal grafting (SBEG) to treat stable vitiligo. METHODS A total of 15 patients with 45 vitiligo patches were recruited. Each vitiligo patch was divided in half; 1 half was treated by UTSG, whereas the other half was treated by SBEG. The patients were followed up monthly for 3 months to assess the repigmentation rate, relative melanin index (RMI), and relative erythema index (REI) at different timepoints. RESULTS Excellent repigmentation was observed in 97.8% of patches that underwent UTSG and 93.3% that underwent SBEG. The RMI and REI at 1, 2, and 3 months after the grafting procedure did not significantly differ between the 2 methods. At the recipient site, incomplete fall-off of the graft occurred in 4.4% of patches that underwent UTSG, whereas a "cobblestone appearance" was observed in 66.7% of patches that underwent SEBG. UTSG caused fewer complications at the donor site than SBEG. CONCLUSION Compared with SBEG, UTSG is faster and achieves better cosmetic outcomes at the recipient and donor sites.
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Affiliation(s)
- Xiaolan Ding
- All authors are affiliated with the Department of Dermatology, Peking University People's Hospital
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15
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Maghfour J, Bardhi R, Huggins R, Hamzavi IH, Mohammad TF. Recipient-to-Donor Ratios in the Surgical Treatment of Vitiligo, Leukoderma, and Piebaldism: A Retrospective Review. Dermatology 2023; 239:828-831. [PMID: 37231873 DOI: 10.1159/000530930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The autologous noncultured melanocyte keratinocyte transplant procedure (MKTP) has emerged as a popular grafting technique with proven efficacy for achieving repigmentation. However, there remains no consensus regarding the optimal recipient-to-donor (RD) ratio required to achieve acceptable repigmentation. In this retrospective cohort study of 120 patients, we sought to examine whether expansion ratios impact the repigmentation success rates following MKTP. RESULTS A total of 69 patients (mean [SD] age was 32.4 [14.3] years, mean follow-up was 30.4 [22.5] months, 63.8% were male; 55% were dark-skinned individuals [Fitzpatrick IV-VI]) were included. The mean percent change in the Vitiligo Area Scoring Index (VASI) was 80.2 (±23.7; RD of 7.3) in patients with focal/segmental vitiligo (SV), 58.3 (±33.0; RD of 8.2) in those with non-segmental vitiligo (NSV), and 51.8 (±33.6; RD of 3.7) in those with leukoderma and piebaldism. Focal/SV was positively associated with a higher percent change in VASI (parameter estimate: 22.6, p value <0.005). In the SV/focal group, non-white patients had a higher RD ratio compared to White individuals (8.2 ± 3.4 vs. 6.0 ± 3.1, respectively, p value = 0.035). DISCUSSION In our study, we found that patients with SV were significantly more likely to achieve higher repigmentation rates compared to those with NSV. Although repigmentation rates were higher in the low expansion ratio group than in the high expansion ratio group, we did not observe a significant difference between the two groups. CONCLUSION MKTP is an effective therapy for restoring repigmentation in patients with stable vitiligo. Therapeutic response of vitiligo to MKTP appears to be influenced by the type of vitiligo, rather than a specific RD ratio.
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Affiliation(s)
- Jalal Maghfour
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA,
| | - Redina Bardhi
- Department of Transitional Year, ProMedica Monroe Regional Hospital, Monroe, Michigan, USA
| | - Richard Huggins
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Tasneem F Mohammad
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
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Altalhab S, Shalaby SS, Saadi DG, Ezzedine K, AlJasser MI. Risk Factors for Infection After Noncultured Melanocyte Keratinocyte Transplantation for Vitiligo. Dermatol Surg 2022; 48:310-314. [PMID: 35125442 DOI: 10.1097/dss.0000000000003388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Noncultured autologous melanocyte keratinocyte transplantation is considered a safe and effective treatment option in stable vitiligo. Factors associated with risk of infection are still poorly explored. OBJECTIVE To search for factors associated with the risk of infection after noncultured autologous melanocyte keratinocyte transplantation (MKTP). METHOD This was a retrospective multicentric study including all patients with vitiligo who had undergone noncultured autologous MKTP between January 2010 and December 2020. Data included age, sex, site, and size of the treated area, recipient area preparation method, and antibiotic prescription preceding the procedure. Univariate and multivariate analyses to search for factors associated with infection after MKTP were conducted. RESULTS A total of 672 patients were included. Infection was present in 39 of the patients (6%) (95% confidence interval [CI]: 4.2%-7.7%). The following factors were independently associated with higher rate of infection: cryotherapy for recipient area preparation (OR 19.76, 95% CI: 3.21-121.74) and treated lesions on the trunk (OR 2.67, 95% CI: 1.21-5.90), lower extremity (OR 5.99, 95% CI: 2.49-14.40), and foot (OR 13.15, 95% CI: 4.37-39.62). CONCLUSION Infection after noncultured autologous MKTP is not uncommon. Cryotherapy for recipient area preparation and lesions on the trunk, lower extremity, or foot was independently associated with an increased risk of infection.
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Affiliation(s)
- Saad Altalhab
- Department of Dermatology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Suzan S Shalaby
- Department of Dermatology, Faculty of Medicine, Cairo University, Egypt
| | - Dina G Saadi
- Department of Dermatology, Faculty of Medicine, Cairo University, Egypt
| | - Khaled Ezzedine
- Department of Dermatology, APHP, Hopital Henri Mondor, Université Paris-Est, Créteil, France
| | - Mohammed I AlJasser
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Mhatre M, Sharma A, Srihari S, Goldust M. Noncultured Epidermal Suspension in Vitiligo-A Review of Origins, Modifications, and Innovations for this Surgical Masterstroke! Skinmed 2021; 19:419-423. [PMID: 35022112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vitiligo, a disorder of depigmentation, has a profound psychosocial burden. Surgical techniques using transplantation of tissue grafts or melanocytes have long been used to correct vitiliginous macules, often utilizing noncultured epidermal suspension. This procedure has undergone a remarkable transformation from its original methods in terms of preparation of recipient site, concentration and separation of melanocytes, incubation, and cryofreezing.Vitiligo is an acquired hypomelanotic disorder characterized by depigmented and circumscribed macules or patches, with loss of melanin and functional melanocytes from the epidermis. There is a broad range of therapeutic options for vitiligo, including topical agents, ultraviolet therapy, oral therapy, and surgical modalities. Transplanting autologous melanocytes from a normally pigmented donor area to the depigmented skin forms a common principle in all surgical techniques-be it grafting at tissue level or cellular level.1Surgical modalities are further divided into tissue grafts and cellular grafts. Tissue grafting includes thin dermoepidermal grafts, punch grafts with full thickness, suction blister grafts, and epidermal harvesting systems. Cellular grafting employs noncultured epidermal suspensions and cultured melanocyte suspensions.1 The advantages of cellular grafting include large areas of depigmentation that can be treated with ease. In noncultured epidermal cell suspensions (NCES), keratinocytes are not separated from melanocytes, and they help to furnish factors that sustain and promote growth of melanocytes and homogeneity of repigmentation.2 A minimum density of melanocytes required for satisfactory repigmentation is 210-250 per mm.2,3.
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Affiliation(s)
| | - Aseem Sharma
- Dermatology Unit, Skin Saga Centre for Dermatology, Mumbai, India;
| | - Sahana Srihari
- Department of Dermatology, Chinmaya Mission Hospital and Phoenix Speciality Clinic, Bengaluru, India
| | - Mohamad Goldust
- Department of Dermatology, University of Rome, G. Marconi, Rome, Italy, & Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Ahmadaghaei F, Kavoussi H, Ebrahimi A, Rezaei M, Kavoussi R, Salimi E. The effect of simplified autologous melanocyte and keratinocyte grafting on the treatment of refractory vitiligo. Acta Dermatovenerol Alp Pannonica Adriat 2021; 30:95-98. [PMID: 34565123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Vitiligo is a disease with a high prevalence and burden that has a negative impact on various aspects of life. Because most cases of vitiligo are not responsive to medical treatment, we performed simplified autologous melanocyte and keratinocyte grafting to treat refractory stable vitiligo. METHODS This interventional study was carried out on 32 patients (16 females and 16 males). After local anesthesia at the donor site, we shaved the donor sites to harvest autologous melanocyte material. The harvested paste-like non-trypsinized material was spread over the abraded recipient area. Patient follow-up was performed to track the treatment outcome and possible complications. RESULTS Out of 32 patients with 99 lesions, the generalized type accounted for 28 (87.5%) patients, and 46 (46.5%) lesions were seen in the upper extremity as the most common clinical type and site of involvement. Eighteen (18.2%) and 26 (26.3%) patches showed excellent and good re-pigmentation, respectively, and face areas showed significantly better re-pigmentation (p < 0.001). CONCLUSIONS Simplified autologous melanocyte and keratinocyte grafting is a safe, simple, office-based, and low-cost procedure with a modest re-pigmentation outcome in refractory stable vitiligo. Moreover, the face area had a satisfactory outcome with this procedure.
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Affiliation(s)
- Fatemeh Ahmadaghaei
- Dermatology Department, Hajdaie Dermatology Clinic, School of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Hossein Kavoussi
- Dermatology Department, Hajdaie Dermatology Clinic, School of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Ali Ebrahimi
- Dermatology Department, Hajdaie Dermatology Clinic, School of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mansour Rezaei
- Health School, Family Health Research Center of Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Reza Kavoussi
- Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Elias Salimi
- Dermatology Department, Hajdaie Dermatology Clinic, School of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
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Akshi B, Shilpa K, Harish P. A novel point-of-care technique to improve graft uptake in a melanocyte-keratinocyte transplantation procedure for vitiligo of contoured areas such as the external ear. J Am Acad Dermatol 2020; 86:e191-e192. [PMID: 32497701 DOI: 10.1016/j.jaad.2020.05.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Bansal Akshi
- Bangalore Medical College and Research Institute, Bengaluru, India.
| | - Kanathur Shilpa
- Bangalore Medical College and Research Institute, Bengaluru, India
| | - Prasad Harish
- Bangalore Medical College and Research Institute, Bengaluru, India
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Jain S, Patra S, Choudhary S, Kaur M. An easy way to make blisters in suction blister grafting of vitiligo with Hijama therapy cups. J Am Acad Dermatol 2020; 86:e149-e150. [PMID: 32454099 DOI: 10.1016/j.jaad.2020.04.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Saurabh Jain
- Atal Bihari Vajpayee Government Medical College, Vidisha, India
| | - Suman Patra
- Department of Dermatology, All India Institute of Medical Sciences, Bhopal, India.
| | - Sanjeev Choudhary
- Department of Dermatology, All India Institute of Medical Sciences, Nagpur, India
| | - Maninder Kaur
- Department of Dermatology, All India Institute of Medical Sciences, Bhopal, India
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Chiu YJ, Perng CK, Ma H. Fractional CO 2 laser contributes to the treatment of non-segmental vitiligo as an adjunct therapy: a systemic review and meta-analysis. Lasers Med Sci 2018; 33:1549-1556. [PMID: 29696444 DOI: 10.1007/s10103-018-2516-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
The treatment of stable non-segmental vitiligo is often challenging, which new therapies are being searched. Multiple clinical trials have proposed the benefits and safety of using fractional carbon dioxide (CO2) laser as an adjunct therapy to conventional treatments. This study aimed to evaluate the safety and efficacy of fractional carbon dioxide laser as a combination therapy to conventional treatments in patients with stable non-segmental vitiligo. A literature search using PubMed, EMBASE, and the Cochrane Library was performed for comparative studies among vitiligo patients treated with additional fractional CO2 laser. Clinical outcomes in the selected studies were compared, and a meta-analysis was performed via Review Manager version 5.3, according to the PRISMA guidelines. Six studies with a total of 184 patches/patients were included in the present meta-analysis. The combination therapy group had significantly superior results than that of the control group (≥ 75% re-pigmentation, risk ratio [RR] 2.80, 95% confidence interval [CI] 1.29-6.07; ≥ 50% re-pigmentation, RR 2.26, 95% CI 1.23-5.9; < 25% re-pigmentation, RR 0.57, 95% CI 0.43-0.75). Limitations of the study included the small number of studies and sample size, inadequate blinding of participants, and variation between therapy protocols. Meta-analysis revealed that using fractional CO2 laser in combination with conventional treatments is efficient and safe, and may be considered as an adjunct therapeutic option for patients with refractive non-segmental vitiligo.
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Affiliation(s)
- Yu-Jen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, 11217, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, 11217, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, 11217, Taiwan.
- Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan.
- Department of Surgery, National Defense Medical Center, Taipei, Taiwan.
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Abstract
Use of the 308 nm Excimer laser to treat hypopigmentation and vitiligo is usually superior to conventional ultraviolet (UV) therapy with regard to results and safety. It is particularly advantageous because specific areas of skin can be targeted without burdening the rest of the skin. Fewer sessions with lower cumulative doses are required. Various combination therapies can improve the outcome; selection criteria such as early initiation of treatment and more frequent sessions with shorter intervals make it easier to decide which patients should be treated and how to achieve the greatest benefit.
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Affiliation(s)
- K Fritz
- Hautärzte- und Laserzentrum Landau (Pfalz), Reduitstr. 13, 76829, Landau, Deutschland.
- Medizinische und Pharmazeutische Universität Carol Davila, Bucharest, Rumänien.
| | - C Salavastru
- Medizinische und Pharmazeutische Universität Carol Davila, Bucharest, Rumänien
- Abteilung für pädiatrische Dermatologie, Colentina-Krankenhaus, Bucharest, Rumänien
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Razmi T M, Parsad D, Kumaran SM. Combined epidermal and follicular cell suspension as a novel surgical approach for acral vitiligo. J Am Acad Dermatol 2017; 76:564-567. [PMID: 28212764 DOI: 10.1016/j.jaad.2016.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Muhammed Razmi T
- 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.
| | - Sendhil M Kumaran
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Matin R. Vitiligo in adults and children: surgical interventions. BMJ Clin Evid 2015; 2015:1717. [PMID: 25800413 PMCID: PMC4371616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The extent and distribution of vitiligo often changes during the course of a person's lifetime and its progression is unpredictable. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical question: What are the effects of surgical interventions for vitiligo in adults and in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found four studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: blister grafts, cultured cellular transplantation, non-cultured cellular transplantation, punch/mini grafts, and split thickness skin grafts.
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Wassef C, Lombardi A, Khokher S, Rao BK. Vitiligo surgical, laser, and alternative therapies: a review and case series. J Drugs Dermatol 2013; 12:685-691. [PMID: 23839187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Vitiligo is a condition caused by the destruction of melanocytes, resulting in areas of skin without pigmentation. While many topical therapies exist for its treatment, not all patients respond to such treatments. Various surgical, laser and other alternative therapies are available for use as well. OBJECTIVE The objective of this review was to describe the various surgical, laser, and alternative therapies available for vitiligo. A literature review was conducted through Pubmed and Ovid using the search terms "Vitiligo treatment", "Vitiligo surgery", "Vitiligo laser". Since no articles were available about needling on both Pubmed and Ovid using the search criteria, individual articles were sought out through Google. RESULTS The literature review yielded many possible surgical interventions including autologous mini-punch grafting, suction epidermal blister grafting, split-thickness grafting, and cultured and noncultured melanocyte keratinocyte transfer. Laser options included the helium-neon and xenon-chloride lasers, with tattooing and needling serving as other options. While all the above techniques can provide improvement to pigmentation in vitiliginous patches, physician comfort and experience are important factors with regards to outcome. Our case series of four patients treated with the needling method yielded favorable results, with repigmentation rates ranging from 25-50%, with one patient having 90% repigmentation. CONCLUSION There are many surgical, laser, and alternative treatment options available for vitiligo when conventional medical therapy fails or for use in conjunction with medical therapies. Autologous mini punch grafting and needling both have minimal equipment requirements and are easy to learn. Physician experience and comfort play a large role in outcome and availability of services.
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Affiliation(s)
- Cindy Wassef
- University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA.
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Sharquie KE, Noaimi AA, Al-Mudaris HA. Melanocytes transplantation in patients with vitiligo using needling micrografting technique. J Drugs Dermatol 2013; 12:e74-e78. [PMID: 23652963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Some cases of vitiligo require melanocyte transplantation, but these surgical techniques have varying degrees of success. OBJECTIVES To perform melanocytes transplantion in patients with vitiligo using a new needling micrografting technique. PATIENTS AND METHODS This interventional case study took place at the Department of Dermatology and Venereology at Baghdad Teaching Hospital from December 2010 to September 2011. Twelve patients with vitiligo were included. A split-thickness skin graft was taken from the normal area and cut into micropieces ranging from 0.1 mm to 0.3 mm in diameter. The recipient area was anesthetized, and the micrografts were then implanted into the dermis using the needling technique. The number of implanted micrografts depended on the size of the recipient area. Follow-up was conducted every 2 weeks for the first month and then every 4 weeks for a further 16 weeks. RESULTS The intake rate of grafting at week 2 ranged from 90% to 100%. The micrografts started producing noticeable pigmentation at week 2, and pigmentation was obvious at week 4. At week 8, the rate of pigmentation ranged from 10% to 90% (25.24%), and at week 16 it ranged from 10% to 100% (61.36%). CONCLUSION This new approach to the treatment of vitiligo delivers rapid and satisfactory pigmentation.
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Affiliation(s)
- Khalifa E Sharquie
- Scientific Council of Dermatology and Venereology, Iraqi Board for Medical Specializations, Baghdad, Iraq.
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Zhou MN, Zhang ZQ, Wu JL, Lin FQ, Fu LF, Wang SQ, Guan CP, Wang HL, Xu A. Dermal mesenchymal stem cells (DMSCs) inhibit skin-homing CD8+ T cell activity, a determining factor of vitiligo patients' autologous melanocytes transplantation efficiency. PLoS One 2013; 8:e60254. [PMID: 23577097 PMCID: PMC3618417 DOI: 10.1371/journal.pone.0060254] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/24/2013] [Indexed: 12/29/2022] Open
Abstract
We here investigated the efficiency of autologous melanocyte transplantation of 23 vitiligo patients by focusing on perilesional skin homing CD8+ T lymphocytes, and studied the potential effect of dermal mesenchymal stem cells (DMSCs) on CD8+ T cell activities in vitro. Out of 23 patients with the autologous melanocyte transplantation, 12 patients (52.17%) had an excellent re-pigmentation, 6 patients (26.09%) had a good re-pigmentation, 5 patients (21.74%) had a fair or poor re-pigmentation. CD8+ T cells infiltrating was observed in the perilesional vitiligo area of all patients. Importantly, the efficiency of the transplantation was closely associated with skin-homing CD8+ T cell activities. The patients with high number of perilesional CD8+ T cells or high level of cytokines/chemokines were associated with poor re-pigmentation efficiency. For in-vitro experiments, we successfully isolated and characterized human DMSCs and skin-homing CD8+ T cells. We established DMSCs and CD8+ T cell co-culture system, where DMSCs possessed significant inhibitory effects against skin homing CD8+ T lymphocytes. DMSCs inhibited CD8+ T cells proliferation, induced them apoptosis and regulated their cytokines/chemokines production. Our results suggest that vitiligo patients’ autologous melanocytes transplantation efficiency might be predicted by perilesional skin-homing CD8+ T cell activities, and DMSCs might be used as auxiliary agent to improve transplantation efficacy.
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Affiliation(s)
- Miao-ni Zhou
- Department of Dermatology, The Third People’s Hospital of Hangzhou, Hangzhou, P. R. China
| | - Zhi-qing Zhang
- Neuroscience Institute, Soochow University, Suzhou, Jiangsu, P. R. China
| | - Ji-long Wu
- Department of Dermatology, The Third People’s Hospital of Hangzhou, Hangzhou, P. R. China
| | - Fu-quan Lin
- Department of Dermatology, The Third People’s Hospital of Hangzhou, Hangzhou, P. R. China
| | - Li-fang Fu
- Department of Dermatology, The Third People’s Hospital of Hangzhou, Hangzhou, P. R. China
| | - Sui-quan Wang
- Department of Dermatology, The Third People’s Hospital of Hangzhou, Hangzhou, P. R. China
| | - Cui-ping Guan
- Department of Dermatology, The Third People’s Hospital of Hangzhou, Hangzhou, P. R. China
| | - Hong-lin Wang
- Shanghai Institute of Immunology, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Aie Xu
- Department of Dermatology, The Third People’s Hospital of Hangzhou, Hangzhou, P. R. China
- * E-mail:
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Reddy RR, Basavapura SM, Chandramouli GA. Mucosal advancement flap: an innovative surgical technique for treatment of lip vitiligo. Dermatol Surg 2012; 39:334-7. [PMID: 23157707 DOI: 10.1111/dsu.12025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee DY, Kim CR, Park JH, Lee JH. Letter to the editor: Involvement of the epidermal grafting area in the recurrence of segmental vitiligo. Dermatol Surg 2012; 38:705-6. [PMID: 23738935 DOI: 10.1111/j.1524-4725.2011.02274.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holla AP, Parsad D. Vitiligo surgery: its evolution as a definite treatment in the stable vitiligo. GIORN ITAL DERMAT V 2010; 145:79-88. [PMID: 20197747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Vitiligo is a common pigmentary disorder which causes immense psychosocial impact on the patients. This condition is still an enigma in terms of its pathogenesis and management. Although there are various treatment modalities, till date none of it takes care of the cause. Surgical management has evolved significantly and given a ray of hope in stable vitiligo. The main purpose is to review the various surgical modalities available along with a look on the milestones and an effort to find answers to "why, when, whom and how" of vitiligo surgery. This article is based on the review of medical literature regarding various surgical management of vitiligo and also author's experience in this particular field. In addition with this review authors tried to shed light on the factors affecting the outcome of vitiligo surgery. The outcome any surgical procedure in vitiligo depends on the proper patient selection, a proper knowledge of this condition and also about its mystery, an expertise in the procedure and a dedication towards patient care. It is certain that surgical modality will be chosen by many with the hope that it succeeds where medical modality fails. However, there is lot of scope for improvement. So more research should happen in this field so that our aim will shift from "any repigmentation" to "complete and normal repigmentation" and we can achieve a scar less healing of those "bruised souls".
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Affiliation(s)
- A P Holla
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lee DY, Choi SC, Park JH, Lee JH, Yang JM, Lee ES. Repigmentation after epidermal grafting of vitiligo epidermis into normal skin in segmental vitiligo. Clin Exp Dermatol 2010; 34:e1019. [PMID: 20055826 DOI: 10.1111/j.1365-2230.2009.03688.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee DY, Choi SC, Lee JH. Comparison of suction blister and carbon dioxide laser for recipient site preparation in epidermal grafting of segmental vitiligo. Clin Exp Dermatol 2009; 35:328-9. [PMID: 19758388 DOI: 10.1111/j.1365-2230.2009.03495.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee DY, Park JH, Choi SC, Lee JH. Comparison of recipient site preparations in epidermal grafting for vitiligo: suction blister and CO2 laser. J Eur Acad Dermatol Venereol 2009; 23:1448-9. [PMID: 19298480 DOI: 10.1111/j.1468-3083.2009.03230.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Alain Taïeb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Diseases, Centre Hospitalier Universitaire of Bordeaux, Bordeaux, France.
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Cervelli V, De Angelis B, Balzani A, Colicchia G, Spallone D, Grimaldi M. Treatment of stable vitiligo by ReCell system. Acta Dermatovenerol Croat 2009; 17:273-278. [PMID: 20021980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The aim of our study was to analyze the results obtained with the ReCell system for surgical treatment of stable vitiligo. At Department of Plastic and Reconstructive surgery, University of Tor Vergata in Rome, we treated 15 patients with stable vitiligo during a 2-year period. The stability of vitiligo lesions varied between 1 and 4 years. The mean stability was 2.25. The disease activity according to Vitiligo Disease Activity Score (VIDA) was 0 in all cases, which means that all patients had a stability of greater than or equal to 1 year. Three (20%) patients had vitiligo vulgaris, seven (46.6%) segmental vitiligo and five (33.3%) focal vitiligo. Repigmentation was assessed using the Vitiligo Area Scoring Index (VASI). The extent of pigmentation was scored as excellent, good, fair, and poor depending on the percentage of repigmentation in the previously depigmented site. The color of the repigmented area was compared with the adjacent normally pigmented area: excellent color match was present in ten (66.6%) and good in five (33.3%) cases. There was no fair or poor outcome. Repigmentation greater than 75% was recorded in 12 (80%) and 25% to 50% repigmentation in three (20%) of 15 patients treated. ReCell is a feasible, simple and safe technique. The method that uses noncultured autologous epidermal suspension is simpler, less expensive, less time consuming, and does not require sophisticated laboratory facilities as compared with the methods employing cultured melanocytes.
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Affiliation(s)
- Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, Policlinico Casilino, University of Tor Vergata, Rome, Italy
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Trupar E, Brychta P. [Perspectives of surgical treatment of vitiligo]. Cas Lek Cesk 2009; 148:129-131. [PMID: 19634273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The absence of causal and poor results of conservative treatment of vitiligo in many cases leads to the search for different treatment possibilities such as surgical treatment. All techniques of surgical treatment of vitiligo are based on autologous melanocytes grafting into the achromatic skin lesions. Individual surgical methods for such treatment differ in the preparation of recipient skin site, in harvesting and processing of autologous melanocytes before their grafting. The surgical treatment is useful for patients with stabile achromatic skin lesions up to 30% of total body surface area in cases in which medical treatment has failed. This article is a review of different surgical techniques in surgical treatment of vitiligo.
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Affiliation(s)
- E Trupar
- Klinika popálenin a rekonstrukcní chirurgie FN Brno, Brno.
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Abstract
BACKGROUND Because of the limitations of medical treatment, various surgical therapies have been developed and are being accepted to treat vitiligo. However, certain areas such as the fingers and toes, palms and soles, lips, eyelids, nipples and areolas, elbows and knees, and genitals are considered difficult-to-treat areas. OBJECTIVE To evaluate data pertaining to individual sites considered to be difficult to treat and highlight that noncultured melanocyte-keratinocyte transplantation (MKT) does not require any special precautions to treat these anatomical sites. METHODS AND MATERIALS Forty patients (13 male and 27 female) with bilateral vitiligo and nine (4 male and 5 female) with unilateral vitiligo were treated using noncultured MKT, for "difficult-to-treat" sites at the National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia, and were analyzed for response according to region. Repigmentation was graded as excellent with 95% to 100% pigmentation, good with 65% to 94%, fair with 25% to 64%, and poor with 0% to 24% of the treated area. RESULTS For bilateral vitiligo, more than 50% of patients treated for difficult sites showed more than 65% repigmentation of the treated areas. For unilateral vitiligo, all of the patients except for two treated for the eyelids showed more than 65% repigmentation of the treated area. CONCLUSIONS The concept of a "difficult-to-treat site" is a relative term and depends upon the technique used. The noncultured MKT does not require any special precautions to treat these anatomical sites. This review may help physicians to change the concept of "difficult-to-treat site."
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Lan CC, Wu CS, Chen GS, Yu HS. Helium-neon laser and topical tacrolimus combination therapy: novel treatment option for vitiligo without additional photocarcinogenic risks. J Eur Acad Dermatol Venereol 2008; 23:344-5. [PMID: 18624863 DOI: 10.1111/j.1468-3083.2008.02846.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hartmann A, Broecker EB, Hamm H. Repigmentation of skin and hairs in stable vitiligo by transplantation of autologous melanocytes in fibrin suspension. J Eur Acad Dermatol Venereol 2008; 22:624-6. [PMID: 18410624 DOI: 10.1111/j.1468-3083.2007.02407.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Redondo P, del Olmo J, García-Guzman M, Guembe L, Prósper F. Repigmentation of vitiligo by transplantation of autologous melanocyte cells cultured on amniotic membrane. Br J Dermatol 2008; 158:1168-71. [PMID: 18363745 DOI: 10.1111/j.1365-2133.2008.08521.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mahmoud BH, Hexsel CL, Hamzavi IH. An update on new and emerging options for the treatment of vitiligo. Skin Therapy Lett 2008; 13:1-6. [PMID: 18373041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Vitiligo is an acquired leukoderma that results from the loss of epidermal melanocytes, and is characterized by macules and patches of depigmented skin. With a relatively high rate of prevalence, vitiligo occurs in localized, generalized, or segmental patterns; it can run a rapidly progressive course or remain stationary. The pathogenesis of vitiligo is not yet fully understood, but the autoimmune hypothesis is the most commonly accepted one, based on which, many treatment modalities have been described. Although many therapeutic options exist and new modalities are still emerging, treatment challenges persist, as not all patients respond to available therapies. Variables that affect the choice of treatment include the extent, distribution, and progression rate of the lesions. Another challenge is the lack of a standardized scoring system, which hampers the production of level 1a evidence studies for the treatment of this condition.
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Affiliation(s)
- B H Mahmoud
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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Parsad D, Gupta S. Standard guidelines of care for vitiligo surgery. Indian J Dermatol Venereol Leprol 2008; 74 Suppl:S37-S45. [PMID: 18688102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. PHYSICIAN'S QUALIFICATIONS: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on) under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. FACILITY Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. INDICATIONS FOR VITILIGO SURGERY: Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. PREOPERATIVE COUNSELING AND INFORMED CONSENT A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure, about the possible future progression of disease and whether more procedures will be needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures and one-to-one discussions. The need for concomitant medical therapy should be emphasized and the patient should understand that proper results take time (a few months to a year). Preoperative laboratory studies include hemogram including platelet counts, bleeding and clotting time (or prothrombin and activated partial thromboplastin time), and blood chemistry profile. Screening for antibodies for hepatitis B surface antigen and HIV is recommended depending on individual requirements. ANESTHESIA Lignocaine (2%) with or without adrenaline is generally used for anesthesia; infiltration and nerve block anesthesia are adequate in most cases. General anesthesia may be needed in patients with extensive lesions. POSTOPERATIVE CARE Proper postoperative immobilization and care are very important to obtain satisfactory results.
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Affiliation(s)
- Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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Herbst RA. [New treatments for vitiligo?]. Med Monatsschr Pharm 2007; 30:379-380. [PMID: 17966288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Sethi S, Mahajan BB, Gupta RR, Ohri A. Comparative evaluation of the therapeutic efficacy of dermabrasion, dermabrasion combined with topical 5% 5-fluorouracil cream, and dermabrasion combined with topical placentrex gel in localized stable vitiligo. Int J Dermatol 2007; 46:875-9. [PMID: 17651178 DOI: 10.1111/j.1365-4632.2007.03226.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vitiligo affects 1% of the world's population with a higher incidence in dark-skinned individuals. Many medical treatments have been attempted with partial success, but recent focus has been on surgical techniques. The aim of this study was to evaluate and compare the therapeutic efficacy of dermabrasion, dermabrasion combined with 5% 5-fluorouracil cream, and dermabrasion combined with topical placentrex gel in the management of localized stable vitiligo. METHODS Thirty patients with localized stable vitiligo (at least three lesions each) were treated. After dermabrasion, a soframycin tulle dressing was placed on the first lesion, a topical 5% 5-fluorouracil dressing on the second, and a topical placentrex gel dressing on the third for 7 days after the procedure, and the patients were followed up for 6 months. RESULTS The efficacy of treatment was highest (73.33%) and most rapid in lesions treated with dermabrasion combined with 5-fluorouracil. Dermabrasion alone and dermabrasion combined with placentrex gel showed similar efficacy in localized stable vitiligo. CONCLUSION Dermabrasion combined with 5-fluorouracil is the most efficacious of the three treatment modalities studied.
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Affiliation(s)
- Shweta Sethi
- Department of Dermatology, GGS Medical College, Faridkot, India
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Hasegawa T, Suga Y, Ikejima A, Muramatsu S, Mizuno Y, Tsuchihashi H, Haruna K, Ogawa H, Ikeda S. Suction blister grafting with CO2laser resurfacing of the graft recipient site for vitiligo. J Dermatol 2007; 34:490-2. [PMID: 17584330 DOI: 10.1111/j.1346-8138.2007.00317.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Nicola Arpaia
- 2nd Unit of Dermatology, MIDIM Department, University of Bari, and Istituto Dermopatico dell'Immacolata, I.D.I., I.R.C.C.S., Rome, Italy
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