A prospective study to assess the efficacy of various surgical modalities in treatment of stable vitiligo patches over resistant sites

Abstract

BackgroundDespite advances in surgical management of vitiligo, lesions on acral areas and bony prominences remain treatment refractory. There is lack of literature on the treatment efficacy of various surgical modalities over these treatment refractory sites.ObjectiveTo compare the efficacy of three common methods of grafting in vitiligo in known resistant areas.MethodsA single‐center interventional clinical trial involving 30 patients of stable vitiligo (disease stability ≥1 year) located over bony prominences and acral areas. All patients were treated with noncultured epidermal cell suspension (NCES), suction blister epidermal grafting (SBEG), and mini punch grafting (MPG) on three separate patches. Extent of repigmentation was assessed at 12 and 24 weeks, color matching and patient satisfaction were evaluated at 24 weeks.ResultsAmong 30 participants, 22 (73%) were females, mean age was 27.4 (±10.7) years, and the majority (93.3%) had nonsegmental vitiligo. At 12 weeks, repigmentation >75% was noted in 56.6, 60, and 16.6% of patches treated by NCES, SBEG, and MPG, respectively. At 24 weeks, results remained the same in both the NCES and SBEG groups, while the number of patches with >75% repigmentation increased to 23.3% in the MPG group. The difference in repigmentation rate between NCES and MPG as well as between SBEG and MPG achieved statistical significance. Color matching of treated area and patient satisfaction were better in NCES and SBEG groups compared to MPG.ConclusionNCES and SBEG are superior to MPG with reasonably good efficacy and can be offered as a therapeutic modality for stable vitiligo patches over these sites.

A prospective, randomized clinical study to compare the efficacy of recipient site preparation using dermabrasion, cryoblister, and dermaroller in autologous noncultured epidermal cell suspension in stable vitiligo

“…In another recent study comparing manual dermabrasion followed by NCES, suction blister epidermal grafting (SBEG) and mini punch grafting (MPG) in resistant sites, that is, acral and bony prominences, NCES and SBEG were found equally effective with good repigmentation and superior to MPG. 20 Cryoblister is less invasive and traumatizing to the patient as compared to manual dermabrasion. However, cryo- full surface erbium laser dermabrasion in autologous cell suspension grafting, 22 which was in accordance with the results of our studies.…”

“…All three interventions in our study were done predominantly over acral areas indicating that the acral patches are more resistant to the medical therapies and hence require surgical modality of treatment for inducing repigmentation. In another recent study comparing manual dermabrasion followed by NCES, suction blister epidermal grafting (SBEG) and mini punch grafting (MPG) in resistant sites, that is, acral and bony prominences, NCES and SBEG were found equally effective with good repigmentation and superior to MPG 20 . Cryoblister is less invasive and traumatizing to the patient as compared to manual dermabrasion.…”

Vitiligo: Translational research and effective therapeutic strategies

“…A recent study found SBEG superior to the punch grafting over acral areas and bony prominences. (Dalla et al., 2020) Ultra‐thin split‐skin grafts with thickness <0.125mm are transplanted over the recipient site and are a very effective tissue graft method. (Awad et al., 2007; Majid & Imran, 2017) Other tissue graft methods include smash grafts (Krishnan & Kar, 2012), flip‐top graft, (McGovern et al., 1999) and hair follicle grafts.…”

Surgical modalities of treatment in vitiligo

“…[22] A recent study found SBEG superior to the punch grafting over acral areas and bony prominences. [23] Modifications are available to speed up the formation of blister, these include heat application, normal saline injected intradermally, use of smaller syringes, and greater negative pressure. [24] An exploitation of alternative system of medicine includes the use of Hijama cups for the creation of negative pressure and blister.…”