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Efficacy of suction blister epidermal grafting with concomitant phototherapy in vitiligo treatment. Postepy Dermatol Alergol 2018; 35:592-598. [PMID: 30618527 PMCID: PMC6320492 DOI: 10.5114/pdia.2017.71257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction There are many surgical methods for vitiligo treatment that have been used for over 30 years. Suction blister epidermal grafting (SBEG) is considered one of the simplest and most effective of them. Aim To determine how effective suction blister grafts with concomitant phototherapy are in vitiligo treatment. Material and methods The study was conducted on 10 patients with vitiligo that was resistant to previous treatment including phototherapy in monotherapy. Involvement of affected sites was different for every patient. We used cryotherapy for blistering at the recipient site and an automatic suction device for blistering at the donor site. The blister was separated from the donor site and fixed with dressing to the recipient site. After removing the final dressing (about 7 days after SBEG) patients started phototherapy (6 patients had UVB 311 nm and 4 had PUVA). All patients treated with UVB 311 nm were qualified for treatment in our clinic and the method was chosen according to expert recommendations from the European Dermatology Forum (EDF) Guidelines for Vitiligo where narrowband (NB) UVB is the phototherapy of choice. Three patients who had PUVA therapy were treated with this method in other clinical centers and sent to us only to undergo SBEG. One patient had previously received UVB 311 nm for 3 months, which showed no effects. Repigmentation of lesions was evaluated at 3 and 6 months after the surgical procedure. Results Ten patients (9 females with a mean age of 36.88 years and 1 man aged 39 years) were enrolled in the study. Nine patients showed progressive repigmentation at 3 and 6 months follow-up with a rate varying from 13 to 76% (mean: 44.5%) and 35 to 100% (mean: 67.5%). One patient showed 5% depigmentation at a visit after 6 months in comparison to the follow-up visit 3 months after SBEG. Conclusions With this technique, patients who did not respond to the usual treatments showed very good repigmentation over a 6-month follow-up. There were no side effects such as scarring.
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Lommerts J, Uitentuis S, Bekkenk M, de Rie M, Wolkerstorfer A. The role of phototherapy in the surgical treatment of vitiligo: a systematic review. J Eur Acad Dermatol Venereol 2018; 32:1427-1435. [DOI: 10.1111/jdv.14950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/28/2018] [Indexed: 12/31/2022]
Affiliation(s)
- J.E. Lommerts
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| | - S.E. Uitentuis
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| | - M.W. Bekkenk
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| | - M.A. de Rie
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
- Department of Dermatology; VU Medical Centre; Amsterdam The Netherlands
| | - A. Wolkerstorfer
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
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Restoring lost gingival pigmentation in the esthetic zone: A case report. J Am Dent Assoc 2015; 146:402-5. [PMID: 26025828 DOI: 10.1016/j.adaj.2014.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/17/2014] [Accepted: 12/20/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OVERVIEW There is insufficient literature on the lack of oral pigmentation in the esthetic zone. The aim of this case report was to illustrate the potential impact of loss of gingival pigmentation in the esthetic zone, describe its surgical treatment, and discuss the limited literature on this topic. CASE DESCRIPTION An African American woman with high smile line had localized loss of gingival melanin pigmentation as a complication after implant failure and attempted guided bone regeneration in site 8. A highly pigmented free gingival graft was collected from the facial-attached gingiva of the maxillary posterior teeth and placed onto the previously de-epithelialized recipient bed in the maxillary front. Some pigmentation of the graft was preserved and was visible a few weeks after surgery; some pigmentation recovered over time. At 6 months after surgery, the patient was satisfied with the esthetics. Complete recovery of pigmentation took 12 months, at which time the patient was ready to proceed with the final prosthetic work. CONCLUSIONS AND PRACTICAL IMPLICATIONS Gingival pigmentation can be restored using a free gingival graft from a highly pigmented area. When surgical procedures are performed in such cases, loss of gingival pigmentation should be part of the informed consent. However, further research, including histology, is needed.
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Abstract
Grafting procedures in vitiligo have become quite popular over the last one or two decades especially in India. Starting with the simplest punch grafting we have now a multitude of different grafting techniques available in vitiligo. All of these grafting procedures are associated with certain complications. In addition there are certain factors and surgical pearls that can go a long way in improving the cosmetic results achieved with any of these grafting techniques. This paper will try to address these specific factors and complications associated with these grafting techniques and the ways and means to avoid them.
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Affiliation(s)
- Imran Majid
- Department of Dermatology, Government Medical College, CUTIS Skin and Laser Institute, Srinagar, Kashmir, India
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Maleki M, Banihashemi M, Sanjari V. Efficacy of suction blister epidermal graft without phototherapy for locally stable and resistant vitiligo. Indian J Dermatol 2012; 57:282-4. [PMID: 22837562 PMCID: PMC3401843 DOI: 10.4103/0019-5154.97669] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Surgical methods for treatment of vitiligo include punch grafts, blister grafts, follicular grafts and cultured melanocyte grafts. The aim of this study was to determine the efficacy of suction blister grafts for treatment of vitiligo, without the use of phototherapy. MATERIALS AND METHODS This clinical trial study was conducted on 10 patients with vitiligo that was resistant to usual treatments and with limited involvement in the affected sites. We used cryotherapy and a manual suction device for blistering at the recipient and donor sites, respectively. The blister was separated and fixed with sutures and a dressing to the recipient site. Repigmentation of lesions was evaluated monthly for 6 months after treatment. Repigmentation rates higher than 90%, between 71%-90%, from 51%-70%, and less than 50% were graded as complete, good, moderate, and poor, respectively. RESULTS Ten patients (five females with a mean age of 23.2±3.96 years and five males with a mean age of 30.60±4.15 years) were enrolled in the study. Reponses to treatment after a 6-month follow-up were 'complete,' 'good,' and 'moderate' in 7 (70%), 1 (10%), and 2 (20%) patients, respectively. CONCLUSION With this technique, patients with restricted sites of involvement, that did not respond to the usual treatments showed very good repigmentation without any additional phototherapy over a 6-month follow-up; moreover, there were no side effects such as scarring.
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Affiliation(s)
- Masoud Maleki
- Research Center for Skin Disease and Cutaneous Leishmaniasis, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Sun X, Qian G, Wu Y, Shen H, Wang T, Hu J, Guo B, Wu J, Xu A. Transplantation of autologous minigrafts for the treatment of stable vitiligo. J DERMATOL TREAT 2011; 23:122-7. [DOI: 10.3109/09546634.2010.507703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Vitiligo is a common depigmenting disorder affecting about 1-2% of the world population. Approximately half of the affected individuals develop the disease before adulthood. Etiologic hypotheses for vitiligo include biochemical, neural and autoimmune mechanisms. The most compelling of these suggests a combination of genetic and immunologic factors that result in an autoimmune melanocyte destruction. We reviewed studies carried out on various treatment modalities used in childhood vitiligo. Topical corticosteroids were found to have excellent repigmentation rates, whereas calcineurin inhibitors have comparable efficacy and a better safety profile compared with topical corticosteroids. These two groups of topical medications are good first-line treatment modalities for localized vitiligo. For the treatment of generalized vitiligo, phototherapy has excellent efficacy. Narrow-band ultraviolet B (UVB) has better overall repigmentation rates and safety profile than either topical or oral psoralens and ultraviolet A (PUVA). Other treatment modalities may be considered depending on a patient's specific condition, such as surgical options and depigmentation. With adequate sun protection, the option of no treatment with or without corrective camouflage, is an innocuous alternative to any of these treatment modalities.
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Fongers A, Wolkerstorfer A, Nieuweboer-Krobotova L, Krawczyk P, Tóth G, van der Veen J. Long-term results of 2-mm punch grafting in patients with vitiligo vulgaris and segmental vitiligo: effect of disease activity. Br J Dermatol 2009; 161:1105-11. [DOI: 10.1111/j.1365-2133.2009.09367.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Sequential displays of several treatment options for vitiligo have been scanned from the literature, and are presented here. A few of the medical modalities have been resigned to history, whereas others have become customary in clinical practice. There has also been a recent surge of interest in the surgical treatment of this disease. Accordingly, this has been appraised and summarized. Special attention has been given to prevalent medical modalities so that they may be effectively utilized by those currently in practice.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, India.
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Hanafusa T, Yamaguchi Y, Nakamura M, Kojima R, Shima R, Furui Y, Watanabe S, Takeuchi A, Kaneko N, Shintani Y, Maeda A, Tani M, Morita A, Katayama I. Establishment of suction blister roof grafting by injection of local anesthesia beneath the epidermis: Less painful and more rapid formation of blisters. J Dermatol Sci 2008; 50:243-7. [DOI: 10.1016/j.jdermsci.2008.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 01/29/2008] [Accepted: 02/04/2008] [Indexed: 12/18/2022]
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Hasegawa T, Suga Y, Ikejima A, Muramatsu S, Mizuno Y, Tsuchihashi H, Haruna K, Ogawa H, Ikeda S. Suction blister grafting with CO2laser resurfacing of the graft recipient site for vitiligo. J Dermatol 2007; 34:490-2. [PMID: 17584330 DOI: 10.1111/j.1346-8138.2007.00317.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nanda S, Relhan V, Grover C, Reddy BSN. Suction blister epidermal grafting for management of eyelid vitiligo: special considerations. Dermatol Surg 2006; 32:387-91; discussion 391-2. [PMID: 16640684 DOI: 10.1111/j.1524-4725.2006.32078.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suction blister epidermal grafting is an established technique for the treatment of resistant and stable vitiligo especially over small and cosmetically important areas like the face. However, certain areas, such as lips and eyelids, require special considerations because of their anatomic peculiarities. PATIENTS AND METHODS The current study was carried out on six patients of stable eyelid vitiligo, not responding to medical treatment. Suction blister was obtained from the thigh using the suction apparatus and the roof was grafted on to the dermabraded eyelid. Certain precautions were taken during the procedure, which will be highlighted in the current study. RESULTS Response was excellent in all the patients in 3 to 6 months, with no complications. CONCLUSIONS If carried out properly, suction blister technique is the procedure of choice for cosmetically important sites like eyelids.
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Affiliation(s)
- Soni Nanda
- Department of Dermatology, Venereology and Leprology, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
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Suction Blister Epidermal Grafting for Management of Eyelid Vitiligo. Dermatol Surg 2006. [DOI: 10.1097/00042728-200603000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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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. [PMID: 14692927 DOI: 10.1111/j.1524-4725.2004.30003.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Punch grafting followed by PUVA is an established therapy for stable vitiligo, but punch grafting followed by topical corticosteroid has never been evaluated. OBJECTIVE The aim of this study was to evaluate the efficacy of topical corticosteroid in perigraft pigmentation and to compare it with perigraft pigmentation after PUVA in patients with stable vitiligo. METHODS Fifty patients with stable vitiligo of various clinical types were subjected to punch grafting. In a randomized case study, these patients were divided into two groups: One group received post punch-grafting PUVA (group I) and the other group post punch-grafting topical application of fluocinolone acetonide 0.1% (group II). During the follow-up period of 6 months, six patients were lost to follow-up, and two patients were excluded from the study; 42 patients were evaluated for pigment spread and side effects. RESULTS In group I, the average pigment spread was 6.38 mm, whereas in group II, it was 6.94 mm, showing a slightly higher pigment spread in group II, which was statistically not significant (P=0.301). There was no difference in response to therapy in patients having segmental vitiligo as compared with nonsegmental vitiligo. Cobblestoning, depigmentation of the grafts, infection, and graft displacement were the important side effects seen in some patients in both the groups. CONCLUSION The study shows that the pigment spread with topical corticosteroid is comparable to that with PUVA. However, the studies with long-term follow-up are required to establish this. The advantages of topical corticosteroid are that its use is easy, less cumbersome, cheaper, and more cost effective than PUVA.
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Affiliation(s)
- Krishna Deb Barman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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A Comparative Study of Punch Grafting Followed by Topical Corticosteroid Versus Punch Grafting Followed by PUVA Therapy in Stable Vitiligo. Dermatol Surg 2004. [DOI: 10.1097/00042728-200401000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gupta S, Kumar B. Epidermal grafting in vitiligo: influence of age, site of lesion, and type of disease on outcome. J Am Acad Dermatol 2003; 49:99-104. [PMID: 12833017 DOI: 10.1067/mjd.2003.415] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The success of suction blister epidermal grafting may be influenced by various factors, all of which have not been studied to date. OBJECTIVE We sought to determine the influence of age of the patient, site of vitiligo patch, and type of disease on the outcome of the procedure in our patients and in the cumulative data derived from literature analysis. METHODS This was a retrospective, uncontrolled case series and literature review of suction blister epidermal grafting in patients with stable and recalcitrant vitiligo. All published studies of suction blister epidermal grafting in vitiligo involving 10 or more patients were included in the literature analysis. RESULTS The procedure was performed in 143 patients. However, sufficient length (6 postoperative months) of follow-up was available in only 117 patients, and only these patients were included for analysis. Only limited information was available about various factors in the majority of published studies. The success rates for generalized and segmental/focal disease in this study were 53% (confidence interval [CI] 42-64) and 91% (CI 81-100), respectively (P <.001), and in the literature, 61% (CI 46-76) and 88% (CI 82-94), respectively (P <.01). The success rates in patients aged < 20 years and >or= 20 years in this study were 82% (CI 67-97) and 58% (CI 48-68), respectively (P <.05), and in the literature, 100% and 66% (CI 56-76), respectively (P <.05). There was no significant difference in the success rates achieved on different body sites in this study and in the screened literature. Among adverse reactions, hyperpigmentation in 32% (CI 24-40) and 17% (CI 14-20), infection in 6% (CI 2-10) and 0%, and contact dermatitis in 1% (CI 0-3) and 1% (CI 0-2) of patients were observed in this study and in the analyzed literature, respectively. CONCLUSIONS The results were significantly better in segmental/focal vitiligo than in the generalized type, and in individuals < 20 years of age. However, unlike in medical therapies, localization of the vitiligo patch did not influence the treatment outcome significantly.
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Affiliation(s)
- Somesh Gupta
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Vitiligo has always been difficult to treat. Several modes of treatment are available, but the therapeutic effect varies greatly, and rarely does one achieve complete repigmentation. One of the most efficient treatment methods is photo(chemo) therapy. Already in ancient Egypt, vitiligo lesions were treated with extracts of the Ammi maius plant followed by exposure to the sun. This principle is at the basis of the photochemotherapy or PUVA therapy, whereby UVA irradiations are given 2 h after administration of 8-methoxypsoralen, a photosensitizer. Another efficient treatment form is UVB phototherapy, particularly narrow-band UVB. This not only gives good therapeutic results but also has the advantage of eliminating the need for a photosensitizer. All these treatments must be applied for many months to be efficient. They can also be combined with various surgical skin-grafting techniques. A newer approach is targeted UVB phototherapy, whereby xenon-chloride lasers or monochromatic excimer light is used.
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Affiliation(s)
- Rik Roelandts
- Photodermatology Unit, University Hospital St Raphael, Kapucijnenvoer 33, 3000 Leuven, Belgium.
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Suga Y, Ikejima A, Matsuba S, Ogawa H. Medical pearl: DHA application for camouflaging segmental vitiligo and piebald lesions. J Am Acad Dermatol 2002; 47:436-8. [PMID: 12196756 DOI: 10.1067/mjd.2002.119670] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yasushi Suga
- Department of Dermatology, Juntendo University School of Medicine, Tokyo, Japan.
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Ozdemir M, Cetinkale O, Wolf R, Kotoğyan A, Mat C, Tüzün B, Tüzün Y. Comparison of two surgical approaches for treating vitiligo: a preliminary study. Int J Dermatol 2002; 41:135-8. [PMID: 12010337 DOI: 10.1046/j.1365-4362.2002.01391.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical techniques have recently been introduced for patients with vitiligo. Randomized controlled trials have not been performed. AIM To compare the efficacy and side-effects of two surgical methods (suction blister vs. thin split-thickness graft technique) for the treatment of vitiligo. METHODS Three suction blisters, approximately 0.8 cm in diameter, made with a special tool attached to a vacuum extractor, which were converted to erosions by removal of the roofs of the bullae, and one round erosion of approximately the same diameter, made using a silver knife, were created. One roof of a blister and two cutaneous thin split-thickness grafts taken from the gluteal region were transferred onto recipient vitiliginous areas; one was left alone. The results were evaluated by one non-blind and two blind observers bimonthly during the 3-month follow-up period. RESULTS Repigmentation rates were 25-65% in the suction blister technique and 90% in the thin split-thickness graft technique (P < 0.001). CONCLUSIONS The thin split-thickness graft technique is superior to the suction blister technique in treating vitiligo.
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Affiliation(s)
- Mustafa Ozdemir
- Departments of Dermatology and Plastic Surgery, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, 80200 Turkey.
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Abstract
Vitiligo is a significant problem in children. Many fail to respond to medical treatment and require melanocyte replenishment with one of the various surgical methods. Epidermal grafting using the tops of suction blisters has been found to be the most effective surgical procedure. However, the results of this procedure have never been delineated separately in adolescents and children. There are certain procedural and outcome differences in epidermal grafting among children and adolescents as compared to adults. We performed epidermal grafting in 15 recalcitrant patches of stable vitiligo in 10 children. Thirteen of 15 patches (86.66%) in 8 of the 10 patients (80%) showed more than 75% pigmentation. The results were much better than the overall response rate of 62% in 142 patients (adults as well as children) found in an earlier study. Literature analysis revealed the same trend in other studies.
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Affiliation(s)
- Somesh Gupta
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
BACKGROUND The literature on suction blister is somewhat confusing regarding suction blister induction time (SBIT). To date, various factors influencing the SBIT have not been discussed comprehensively. OBJECTIVE To determine the effect of diameter of suction syringes/cups on SBIT and review the factors influencing SBIT. METHODS Five young patients (four females, one male; age range 16-27 years, average age 23 years) were selected for the study. Five suction syringes of 2, 5, 10, 20, and 50 ml capacity (diameter 1, 1. 4, 1.7, 2.2, and 3.2 cm, respectively) were applied on the lateral aspect of the thigh and observed for production of unilocular blister at 15 minute intervals. RESULTS The average SBIT was 63, 72, 98, 123, and 208 minutes in 2, 5, 10, 20, and 50 ml syringes, respectively. CONCLUSIONS The SBIT is directly proportional to the diameter of the suction syringe. A literature review suggests that the site of the suction blister, age of the subject, amount of vacuum created, temperature, intradermal injection of saline, corticosteroid-induced atrophy, and pretreatment of the site with PUVA are the important factors influencing the SBIT. Use of 10 or 20 ml syringes as suction cups and -300 mmHg pressure are appropriate choices for suction blister induction and produce blisters in about 1-2 hours.
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Affiliation(s)
- S Gupta
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Vitiligo is a common skin disease; however, it still remains a difficult disease to treat. Not all patients respond to current forms of treatment. There are several new treatments, surgical and nonsurgical, and immunologic, that appear to either have higher success rates than past therapies or have potential as future developments for therapy of vitiligo.
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Affiliation(s)
- R M Halder
- Department of Dermatology, Howard University College of Medicine, Washington, DC, USA
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Abstract
BACKGROUND Suction blister epidermal grafting is a useful modality of treatment of resistant and stable vitiligo; however, it requires expensive and heavy suction apparatus. This study is an attempt to develop a cheap and small apparatus which can be assembled in the physician's own office. PATIENTS AND METHODS The method was tried in 22 vitiligo/leukoderma patients. The apparatus consisted of a cylindrical funnel connected with a three-way tap, and suction was given by a 50-mL syringe. The pressure inside the suction cup was retained by changing the position of lock of the three-way tap. The pressure was measured by connecting the three-way tap to a vacuum gauge. The apparatus remained adhered to the donor area because of negative pressure. The blister was formed in about 1.5 h. The roof of the blister was grafted onto the dermabraded recipient site. RESULTS The pigmentation was complete in 20 out of 22 patients. There were no complications. CONCLUSIONS The technique is inexpensive and easy and obviates the need of cumbersome and heavy equipment.
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Affiliation(s)
- S Gupta
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
BACKGROUND Epidermal autografting has been used to treat vitiligo. The pigmentation achieved at the recipient site can be variegated and incomplete compared with that of the surrounding normal skin, and sometimes remains that way for a fairly long time. OBJECTIVE We investigated whether the clinical results from epidermal autografting are related to a change in the number of melanocytes. This was performed by counting the number of melanocytes in the epidermis obtained from biopsy and suction with and without psoralen plus UVA (PUVA) exposure of the donor sites before grafting. METHODS The numbers of melanocytes in the epidermis were counted after staining with dopa. The epidermis from suction and biopsy was included. The biopsied specimen was treated with NaBr for dermo-epidermal separation before staining, whereas the epidermis obtained from suction was stained directly. RESULTS The epidermis obtained from suction contained 40-60% of the number of melanocytes found in the biopsied epidermis. Melanocytes around the hair follicles seemed to be omitted. Treatment with PUVA 10-21 times caused the number of melanocytes to increase by 1.5-2 times the normal level with a promising clinical result. CONCLUSIONS The preparation of donor sites with PUVA before the treatment of vitiligo by epidermal autografting induced an increased number of melanocytes and improved the clinical result.
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Affiliation(s)
- A Y Lee
- Department of Dermatology, Nowon Eulji Hospital College of Medicine, Seoul, South Korea
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Abstract
The destruction of melanocytes is the cause of depigmented maculae that clinically represent the disease vitiligo. Although the cause is unknown, various theories such as the autoimmune, autocytotoxic, and neural hypotheses have been proposed. Extensive research has provided numerous answers regarding the pathogenesis, histopathologic evidence, and treatment of vitiligo. This discussion of vitiligo summarizes the varied clinical presentations of the disease, theories attempting to explain the mechanism of melanocyte destruction, histopathologic findings, and different treatment modalities currently available.
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Affiliation(s)
- S O Kovacs
- Department of Dermatology, Barnes Hospital, St. Louis, Missouri, USA
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