Erbium:YAG Laser and Cultured Epidermis in the Surgical Therapy of Stable Vitiligo

Abstract

To induce complete and reproducible repigmentation of large "stable" vitiligo lesions by means of autologous cultured epidermal grafts using a rapid, simple, and minimally invasive surgical procedure.Design: Achromic epidermis was removed by means of appropriately settled erbium:YAG laser, and autologous epidermal grafts were applied onto the recipient bed. Melanocyte content was evaluated by dopa reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system.Setting: A biosafety level 3-type cell culture facility, a surgical ambulatory department, and a dermatological department in a hospital.Patients: Twenty-one patients with different types of vitiligo were admitted to the study and treated with autologous cultured epidermal grafts. Inclusion criteria were failure of at least 2 standard medical approaches; no therapy for at least 12 months; no progression of old lesions or appearance of new lesions; no Koebner phenomenon within the past 18 months; and no autoimmune disorders. Results:The average percentage of repigmentation in 21 patients was 75.9% (1759.7 cm 2 repigmented/2315.8 cm 2 transplanted). Three patients showed a reactivation of their vitiligo and did not show repigmentation. The remaining 18 patients, with 43 distinct lesions, showed an average percentage of repigmentation of 90% (1759.7 cm 2 repigmented/1953.4 cm 2 transplanted).Conclusions: Under appropriate conditions, cultured epidermal grafts induce complete repigmentation of stable vitiligo lesions. Erbium:YAG laser surgery can supply a fast and precise tool for disepithelialization, hence allowing treatment of large vitiligo lesions during a single surgical operation.

Surgical interventions for vitiligo: an evidence-based review

“…Different modifications have been used to culture and transplant the cells in an attempt to enhance efficacy of the procedures. [26][27][28][29][30][31] The percentage repigmentation reported with cultured techniques ranges from 75-84% in patients with focal vitiligo/SV, to 30-54% in those with generalized vitiligo. 29,30 Noncultured cell transplantation, introduced as a 2-day procedure, 32 was modified by Olsson and Juhlin 33 as a day-care procedure with donor: recipient ratio of 1: 10. van Geel et al 34 added hyaluronic acid to increase the viscosity of the suspension, and Mulekar and colleagues 35,36 simplified the procedure by eliminating all supplements such as fibroblast growth factor and laminar flow bench and replacing carbon dioxide with an ordinary incubator.…”

Long-term Follow-up Study of Segmental and Focal Vitiligo Treated by Autologous, Noncultured Melanocyte-Keratinocyte Cell Transplantation

“…Falabella 1 observed that 12 of 13 patients with segmental vitiligo improved with complete or near complete repigmentation, and 2 of 4 patients with focal vitiligo improved with complete repigmentation. Guerra et al 11 reported that of 6 patients with focal vitiligo, 3 had complete and 2 had partial repigmentation, and all 4 patients with segmental vitiligo had near complete repigmentation. In the present study, I have observed that repigmentation failed to be produced in 10% of patients in the segmental vitiligo group and 20% in the focal vitiligo group.…”

Nonirradiated Human Fibroblasts and Irradiated 3T3-J2 Murine Fibroblasts as a Feeder Layer for Keratinocyte Growth and Differentiation in vitro on a Fibrin Substrate

“…As a standardized method for producing graftable epithelia is based on the presence of a feeder layer of lethally irradiated 3T3-J2 murine fibroblasts (3T3-J2 MFs) [Rheinwald and Green, 1975;Pellegrini et al, 1999;Guerra et al, 2000Guerra et al, , 2003Guerra et al, , 2004, we tested the new culture system using keratinocytes grown on a fibrin gel precoated with 3T3-J2 MFs as a control.…”