Is it possible to repigment iatrogenic and traumatic hypochromic lesions? A case series using the MMP^® drug delivery technique with 5‐fluorouracil and bleomycin

Abstract

Objectives We present the results of 11 patients with hypochromic lesions treated with antifibrotic agents delivered through the MMP® technique. Methods Eleven patients with hypochromic lesions because of external injuries were treated at a single clinic with 5‐fluorouracil (5‐FU) and/or bleomycin using the MMP® drug delivery technique. Treatment sessions were repeated at 30‐day intervals until patient satisfaction. The primary outcome was repigmentation of the lesions, assessed independently by two dermatologists and by the patient. Results The MMP® technique injected 0.048 mg/cm2 of 5‐FU or 0.0028 U/cm2 of bleomycin. The accumulated 5‐FU and bleomycin density per patient ranged from 0.02 to 0.77 mg and 0.0022 to 0.2800 U/ml, respectively. Patients were treated with 1 to 6 MMP® sessions with 5‐FU (3 patients), bleomycin (6 patients), or both drugs (2 patients). After the last session, all patients had a significant improvement (>75%) of the lesions compared to baseline. There were no procedure‐related short‐ or long‐term adverse effects in any of the participants up to their last follow‐up visit. Conclusions The injection of antifibrotic agents using the MMP® technique was effective and safe in the treatment of hypochromic lesions. This can be a new therapeutic option for these lesions.

Unveiling idiopathic guttate hypomelanosis: pathology, immunohistochemistry, and ultrastructural study

“…(5-FU and bleomycin) through drug delivery. 26 This is the first study to identify and correlate melanogenesis with subjacent dermal fibrosis in IGH. The fact that a single researcher (the first author) performed all surgical procedures and sectioned all specimens was important to reduce bias and to improve the quality of histological slides.…”

“…As in IGH, these melanocytes do not seem to produce and/or transfer melanin to keratinocytes. In a recent publication, we reported repigmentation of achromic scars after injecting antifibrotic agents (5‐FU and bleomycin) through drug delivery 26 …”

Efficacy and Safety of 5-Fluorouracil Tattooing to Repigment Idiopathic Guttate Hypomelanosis: A Split-Body Randomized Trial

“…The first author conducted all procedures 21 and took all photographs. After cleaning the affected skin of the first limb with a 2% chlorhexidine solution, he used a tattoo machine (approved by the Brazilian health agency for medical use) with 2 disposable sterile cartridges with 7 needles, without local anesthesia.…”

“…5 5-fluorouracil (5FU), an effective antifibrotic agent 14 that stimulates melanin spread and melanocyte migration and proliferation, 15 can be safely injected into achromic and hypertrophic lesions using microneedling techniques. 13,16 In 2018, we obtained good results treating IGH with 5FU delivery using a tattoo equipment. 17 Similar findings were reported by other researchers using comparable procedures.…”

“…Repigmentation of achromic scars can occur after surgical removal of dermal fibrosis 12 or drug delivery of antifibrotic agents. 13 We hypothesized that the reduction or elimination of subjacent dermal fibrosis could repigment IGH lesions. 5 5-fluorouracil (5FU), an effective antifibrotic agent 14 that stimulates melanin spread and melanocyte migration and proliferation, 15 can be safely injected into achromic and hypertrophic lesions using microneedling techniques.…”