Efficacy of ultrathin epidermal grafting followed by narrow band ultraviolet B therapy for stable vitiligo: a novel therapy
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20200550Keywords:
Vitiligo, Ultrathin epidermal grafting, NBUVBAbstract
Background: Different surgical techniques in the form of tissue or cellular grafting procedures are used alone or in combination with narrow band ultraviolet B (NBUVB) to treat stable vitiligo resistant to medical treatment. The aim of the study was to assess the cosmetic results obtained with combination therapy of ultrathin split-thickness skin grafts and adjuvant NBUVB therapy in resistant, stable vitiligo.
Methods: Forty patients of stable vitiligo were treated with ultrathin split-thickness grafting and the patients were then put on NBUVB therapy. Extent of repigmentation and final cosmetic outcome at the recipient as well as donor sites were assessed.
Results: The initial evidence of repigmentation was noted in the second week after starting NBUVB. Results showed 85% of patients had more than 90% repigmentation and the overall cosmetic results at the recipient site was good to excellent in 90% patients at the end of NBUVB treatment. Perigraft halo of depigmentation was seen in five patients (12%) on the recipient site. Hypertrophic scarring was seen in two patients at the donor site.
Conclusions: Ultrathin split-thickness skin grafting, when combined with NBUVB therapy, leads to better cosmetic outcome with faster onset of repigmentation in resistant and stable vitiligo.
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References
Mattoo SK, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in vitiligo: Prevalence and correlates in India. J Eur Acad Dermatol Venereol. 2002;16:573-8.
Aghaei S, Sodaifi M, Jafari P, Mazharinia N, Finlay AY. DLQI scores in vitiligo: Reliability and validity of the Persian version. BMC Dermatol. 2004;4:8.
Kovacs SO. Vitiligo. J Am Acad Dermatol. 1998;38:647-66.
Njoo MD, Spuls PI, Bos JD, Westerhof W, Bossuyt PM. Nonsurgical repigmentation therapies in vitiligo: Meta-analysis of the literature. Arch Dermatol. 1998;134:1532-40.
Hann SK, Im S, Bong HW, Park YK. Treatment of stable vitiligo with autologous epidermal grafting and PUVA. J Am Acad Dermatol. 1995;32:943-8.
Awad SS, Abdel-Raof H, Hosam El-Din W, El-Domyati M. Epithelial grafting for vitiligo requires ultraviolet-A phototherapy to increase success rate. J Cosmet Dermatol. 2007;6:119-24.
Savant SS. Surgical therapy of vitiligo: Current status. Indian J Dermatol Venereol Leprol. 2005;71:307-10.
Lahiri K, Malakar S, Sarma N, Banerjee U. Repigmentation of vitiligo with punch grafting and narrow-band UV-B (311 nm) a prospective study. Int J Dermatol. 2005;45:649-55.
Lahiri K, Malakar S. Inducing repigmentation by regrafting and phototherapy (311 nm) in punch failure cases of lip vitiligo: A pilot study. Indian J Dermatol Venereol Leprol. 2004;70:156-8.
Elisa P, Massimiliano R, Andre A, Paolo T, Francesca I, Lucio A. Autologous epidermal cultures and narrow-band ultraviolet B in the surgical treatment of vitiligo. Dermatol Surg. 2005;31:155-9.
Barman KD, Khaitan BK, Verma KK. A comparative study of punch grafting followed by topical corticosteroid versus punch grafting followed by PUVA therapy in stable vitiligo. Dermatol Surg. 2004;30:49-53.
Al-Mutairi N, Manchanda Y, Al-Doukhi A, Al-Haddad A. Long- term results of split-skin grafting in combination with excimer laser for stable vitiligo. Dermatol Surg. 2010;36:499-505.
Parsad D, Gupta S. Standard guidelines of care for vitiligo surgery. Indian J Dermatol Venereol Leprol. 2008;74:37-45.
Falabella R. Repigmentation of stable Leukoderma by autologous mini-grafting. J Dermatol Surg Oncol. 1986;12:172-9.
Gupta S, Shroff S, Gupta S. Modified technique of suction blistering of epidermal grafting in vitiligo. Int J Dermatol. 1999;38:306-9.
Kahn AM, Cohen MJ. Repigmentation in vitiligo patients- melancocytes transfer via ultra-thin grafts. Dermatol Surg. 1998;24:365-7.
Achauer BM, Le Y, Vander Kam VM. Treatment of vitiligo with melanocytic grafting. Ann Plast Surg. 1994;33:644-6.
Na GY, Seo SK, Choi SK. Single hair grafting for the treatment of vitiligo. J Am Acad Dermatol. 1998;38:580-4.
Babu A, Thappa DM, Jaisankar TJ. Punch grafting versus suction blister epidermal grafting in the treatment of stable lip vitiligo. Dermatol Surg. 2008;34:166-78.
Falabella R. Surgical therapies for vitiligo and other leukodermas, part 1: Minigrafting and suction epidermal grafting. Dermatol Ther. 2001;14:7-14.
Agrawal K, Agrawal A. Vitiligo: Repigmentation with dermabrasion and thin split-thickness skin graft. Dermatol Surg. 1995;21:295-300.
Njoo MD, Westerhof W, Bos JD, Bossuyt PM. A systematic review of autologous transplantation methods in vitiligo. Arch Dermatol. 1998;134:1543-9.
Olsson M, Juhlin L. Long-term follow-up of leukoderma patients treated with transplants of autologous cultured melanocytes, ultra-thin epidermal sheets and basal cell layer suspension. Br J Dermatol. 2002;47:893-904.
Khunger N, Kathuria SD, Ramesh V. Tissue grafts in vitiligo surgery - Past, present, and future. Indian J Dermatol. 2009;54:150-8.
Grimes PE, Billips M. Childhood vitiligo: clinical spectrum and therapeutic approach. In: Hann SK, Nordlund JJ, editors. Vitiligo, a monograph on the basic and clinical science. Oxford: Blackwell Science; 2000: 61-69.
Njoo MD, Spuls PI, Bos JD, Westerhof W, Bossuyt PMM. Nonsur- gical repigmentation therapies in vitiligo, meta-analysis of the literature. Arch Dermatol. 1998;134:1532-40.
Morrison WL. PUVA therapy. In: Hann SK, Nordlund JJ, editors.Vitiligo, a monograph on the basic and clinical science. Oxford: Blackwell Science; 2000: 168-172.
Niessen FB, Andriessen MP, Schalkwijk J, Visser L, Timens W. Ke- ratinocyte-derived growth factors play a role in the formation of hypertrophic scars. J Pathol. 2001;194:207-16.
Halaban R. The regulation of normal melanocyte proliferation.Pigment Cell Res 2000;13:4-14.
Abdel-Malek ZA, Swope VB, Nordlund JJ, Medrano EE. Proliferation and propagation of human melanocytes in-vitro are affected by donor age and anatomical site. Pigment Cell Res. 1994;7:116-22.
Gilchrist BA, Vrabel MA, Flynn E, Szabo G. Selective cultivation of human melanocytes from newborn and adult epidermis. J In- vest Dermatol. 1984;83:370-6.
Suga Y, Butt KI, Takimoto R, Fujioka N, Yamada H, Ogawa H.Successful treatment of vitiligo with PUVA-irradiated autolo- gous epidermal grafting. Int J Dermatol. 1996;35:518-22.
Hatchome N, Kato T, Hachiro T. Therapeutic success of epidermal grafting in generalized vitiligo is limited by Koebner phenomenon. J Am Acad Dermatol. 1990;22:87-91.
Koga M, Tango T. Clinical features and course of type A and type B vitiligo. Br J Dermatol. 1988;118:223-8.
Jee SH, Kuo YF, Wu YC, Chang CH, Kuo WL, Lu YC. Growth of human melanocytes from suction blister of localized vitiligo patient and from foreskins of newborns and adults by modified culture medium. J Formos Med Assoc. 1993;92:7-14.
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