Punch Grafting Successfully Repigments Vitiligo

By: DAMIAN MCNAMARA

PHOENIX — Dermatologists can easily and effectively repigment the skin of patients with segmental or focal vitiligo, according to a study that demonstrated an 87% graft survival rate.

Researchers reviewed the charts of patients with vitiligo who had autologous epidermal punch grafting from 2003 to 2008. Repigmentation was successful in 26 of 30 patients (87%), including 10 patients who had a greater than 50% response.

Current vitiligo treatments include topical steroids and topical immunomodulators, as well as phototherapy with narrow-band UVB or psoralen plus UVA (PUVA). These treatments, however, are not effective for everyone or for every anatomic site, especially the hands, knees, and feet, said Dr. Joanna L. Chan, a third-year dermatology resident at the University of Texas Southwestern Medical Center, Dallas.

“Some patients might benefit from surgical options in refractory areas or those with segmental or focal vitiligo,” Dr. Chan said in a poster presentation at the joint annual meeting of the American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery.

Dr. Chan and her associates used flip-top pigment transplantation grafting (Arch. Dermatol. 1999;135:1305–7).

“Flip-top grafts are fabulous,” said session moderator Dr. Kavita Mariwalla. “I would do this for anyone with stable vitiligo, and anywhere but on the hands or ankles.” The grafting technique is easy to learn, added Dr. Mariwalla of Yale University, New Haven, Conn., and Stony Brook (N.Y.) University Medical Center.

Transplantation was done to a total of 44 anatomic sites in 30 patients. A total of 530 of the 606 grafts survived. The patients’ median age was 36 years. The study included a wide range of skin types: 5 patients had Fitzpatrick skin type II; 8 patients had type III; 11 patients had type IV; 4 patients had type V; and 2 patients had type VI skin.

The investigators compared photos before treatment and at the final visit to gauge response. Minimum follow-up was 10 weeks. Results were rated as worsening or no improvement, 0%–25% improvement, 25%–50% improvement, 50%–75% improvement, and 75%–100% improvement, said Dr. Chan.

“This is successful in most patients,” Dr. Chan said. Response correlated with demographics, including age, anatomic location, and concomitant therapy. Younger patients had the most successful treatment. Those 20 years and younger had an average 61% repigmentation rate, compared with 38% for patients 60 years and older.

The best responses were observed on the neck and trunk; moderate responses were noted on the arms, legs, and face; and the lowest repigmentation was seen on hands and feet, she said. The lower abdomen was the most common donor site.

Most patients had some form of concomitant phototherapy—26 patients had narrow-band UVB and 4 patients had PUVA. Patients with the greatest response were most compliant with subsequent phototherapy. “I wait 1–2 months [after grafting] before phototherapy,” Dr. Chan said.

Other concomitant therapies included clobetasol (12 patients), tacrolimus (3 patients), prednisone (2 patients), and pimecrolimus (1 patient).

No pain, infections, or bleeding complications were reported, she said. Future research is warranted to improve the success rate using autologous epidermal punch grafting with concomitant therapies.

H. Jill Feetham, a medical student at the UT Texas Southwestern Medical Center in Dallas, provided research support. Both she and Dr. Chan reported having no conflicts of interest.

To see a video interview with Dr. Chan, go to www.youtube.com/SkinAndAllergyNews.

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