Efficacy of erbium YAG laser-assisted autologous epidermal grafting in vitiligo

Treatment of vitiligo with khellin liposomes, ultraviolet light and blister roof transplantation

BACKGROUND

Various surgical and non-surgical methods are available to treat vitiligo. Surgical techniques such as epidermal blister graft transplantation may be effective for the re-pigmentation of stable, but refractory vitiligo areas. Khellin has phototherapeutic properties that are similar to those of the psoralens, but with substantially lower phototoxic effects and DNA mutation effects. Its penetration into the hair follicles is enhanced by encapsulating it into liposomes. Subsequent activation of the khellin with UV light stimulates the melanocytes in the hair follicles.

OBJECTIVE

The first objective was to evaluate the additional value of combining blister roof transplantation (BRT) with khellin in liposomes and ultraviolet light (KLUV) in the treatment of recalcitrant vitiligo patches. The second objective was to assess patients' satisfaction.

MATERIALS AND METHODS

Nineteen patients with vitiligo lesions which did not respond to KLUV treatment for at least a year were treated with BRT followed by KLUV. The transplantation was performed by creating blisters with a suction device, preparing the target site with Erbium laser ablation and the actual transplantation. Locations where randomly assigned. A blinded observer established the results.

RESULTS

Seventy-five percent of the patients were satisfied with the cosmetic result. All of the patients would recommend the treatment to other vitiligo patients. More than 75% re-pigmentation of the vitiligo areas was noted in 47% of the patients according to the blinded evaluation of photographs taken before and after the treatment.

Interaction of extracellular matrix protein 1 with extracellular matrix components: ECM1 is a basement membrane protein of the skin

The extracellular matrix protein 1 (ECM1) is a secreted glycoprotein, which plays an important role in the structural and functional biology of the skin as demonstrated by the identification of loss-of-function mutations in ECM1 as cause of the genodermatosis lipoid proteinosis, characterized by reduplication of the skin basement membrane and hyalinization of the underlying dermis. To search for binding partner(s) of ECM1, we tested the in vitro binding activity of ECM1a, a major isoform of four ECM1 splice variants, to different skin extracellular matrix proteins (such as laminin 332, collagen type IV, and fibronectin) and polysaccharides (such as hyaluronan, heparin, and chondroitin sulfate A) with solid-phase binding assay. We demonstrated that ECM1a utilizes different regions to bind to a variety of extracellular matrix components. Ultrastructurally, ECM1 is a basement membrane protein in human skin and is part of network-like suprastructures containing perlecan, collagen type IV, and laminin 332 as constituents. Furthermore, ECM1a enhanced the binding of collagen IV to laminin 332 dose-dependently, showing its involvement in the dermal-epidermal junction and interstitial dermis and making the functional link to the pathophysiology of lipoid proteinosis. To our knowledge, this is previously unreported.

Pigmentary disorders in Western countries

Countries in the so-called "Western" world, especially in Europe, witnessed a dramatic change in ethnic backgrounds of their populations starting in the last decennia of the last century. This had repercussions on various aspects of our society, including medical practice. In dermatology for instance, pigmentary disorders are seen more often, and the clinical pictures and their impact on patients are different from what doctors and researchers are used to and trained for. In this article, the experience from the Netherlands Institute for Pigment Disorders and the multicenter designed Netherlands guideline on vitiligo are described and the importance of the patient's point of view, as can be measured by patient reported outcomes like quality of life, is emphasized.

Treatment of periungual vitiligo with Erbium-YAG-laser plus 5-flurouracil: a left to right comparative study

Despite the multiple treatment modalities available for vitiligo, none of them gives satisfactory results in the periungual type. In this study we tried to explore and evaluate the effects of the combination treatment of erbium:YAG laser resurfacing and topical 5-flurouracil in periungual vitiligo. Nine adult patients presenting with periungual vitiligo lesions were included in this prospective left-right comparative study. The desirable inflammation was achieved after a mean of 4.7 days of 5-flurouracil application. The mean re-epithelization time in the treatment sessions was 11.3 days. The patients received a mean of 3.4 sessions in a mean duration of 7.6 months. The mean overall response to therapy in the treated group was 47.8% while in the control group it was 1.1% (P < 0.0001). No side effects necessitated the stoppage of treatment. This study points to the efficacy and safety of this combination in the treatment of periungual vitiligo.

Autologous Punch Grafting for Vitiligo of the Palm

BACKGROUND

Vitiligo of the palm can be resistant to conventional treatments, and grafting is not routinely attempted because of some difficulties.

OBJECTIVE

To do a autologous minigraft test on a vitiligo patch on the palm using skin of the instep as the donor.

METHODS

Under local anesthesia, two 2 mm minigrafts were transplanted into the vitiliginous skin of the palm of a 28-year-old female. Psolaren with ultraviolet A therapy followed the surgery for 12 weeks.

RESULTS

Excellent repigmentation was seen around the grafts at the end of 12 weeks. There were no complications.

CONCLUSION

The skin of the instep is an ideal donor site for palmar vitiligo.

Autografts and cultured epidermis in the treatment of vitiligo

Skin transplants can be a useful and efficacious method to treat vitiligo. The aim is to repopulate areas lacking melanocytes with functional cells taken from normally pigmented areas. Several procedures have been devised and tested: some consist in the simple transfer of epidermis sampled and implanted as is, whereas others are based on the transplantation of disaggregated and manipulated cells. The therapeutic success of the former methods is partly determined by the ability and experience of the surgeon performing the operation, whereas the results of the latter methods mainly depend on the laboratory facilities and abilities of the personnel who manipulate the cells to be transplanted. The transplantation of cultured cells is the most fascinating and promising procedure but requires the observance of still not completely predictable procedures. The use of biological material of animal origin and the use of factors to stimulate cell proliferation, such as growth factors and promoting agents, are other points that require attention.