Multimodal Single-Step Vitiligo Surgery: A Novel Approach (original) (raw)
Related papers
Surgical Management of Vitiligo
2020
INTRODUCTION The Aim of this clinical review essay is to highlight various surgical modalities employed in the treatment of vitiligo and concisely explain the procedure of each of them along with the merits and demerits. Further, an attempt has been made to briefly compare the different procedures. Hence a literature search was done, primarily with the aid of electronic resources. Multiple databases, such as systematic reviews, PubMed, Medline as well as online journals from reputed publications were adopted for stating the facts and bibliography. Online search engine, Google Scholar, was periodically used to trace the original source of a citation. Pictures have primarily been adapted from the internet. Constant critiquing of the data, to examine and point out any bias has been endeavoured. *Corresponding Author: Dr. Waleed Tariq Karra
Updates in Surgical Treatment of Vitiligo
Journal of Recent Advances in Medicine
Background: Vitiligo is a common cutaneous disorder of depigmentation. Surgical treatment of vitiligo is considered the final resort of repigmentation in lesions failing to respond for various medical and light therapies. The tissue and cellular graft techniques are used for the successful introduction of melanocytes into the vitiligo lesions. Stability of vitiligo is the cornerstone of evaluation before surgery. Tissue graft includes various techniques of transferring the healthy pigmented skin as a whole without processing to the vitiliginous skin, while the cellular graft involves further processing of these grafts into cellular components which are then applied on the recipient site after dermabrasion either as such or after multiplication in culture media. Aim: To outline current modalities for surgical treatment of vitiligo. Conclusion: Preparation of recipient-site is considered a crucial step for achieving a successful repigmentation. Multiple promising surgical modalities for vitiligo are continuous in the ongoing research and clinical trials to improve the repigmentation outcomes cosmetically with decreasing the time and the cost.
International Journal of Dermatology, 2020
Background Despite advances in surgical management of vitiligo, lesions on acral areas and bony prominences remain treatment refractory. There is lack of literature on the treatment efficacy of various surgical modalities over these treatment refractory sites. Objective To compare the efficacy of three common methods of grafting in vitiligo in known resistant areas. Methods A single-center interventional clinical trial involving 30 patients of stable vitiligo (disease stability ≥1 year) located over bony prominences and acral areas. All patients were treated with noncultured epidermal cell suspension (NCES), suction blister epidermal grafting (SBEG), and mini punch grafting (MPG) on three separate patches. Extent of repigmentation was assessed at 12 and 24 weeks, color matching and patient satisfaction were evaluated at 24 weeks. Results Among 30 participants, 22 (73%) were females, mean age was 27.4 (AE10.7) years, and the majority (93.3%) had nonsegmental vitiligo. At 12 weeks, repigmentation >75% was noted in 56.6, 60, and 16.6% of patches treated by NCES, SBEG, and MPG, respectively. At 24 weeks, results remained the same in both the NCES and SBEG groups, while the number of patches with >75% repigmentation increased to 23.3% in the MPG group. The difference in repigmentation rate between NCES and MPG as well as between SBEG and MPG achieved statistical significance. Color matching of treated area and patient satisfaction were better in NCES and SBEG groups compared to MPG. Conclusion NCES and SBEG are superior to MPG with reasonably good efficacy and can be offered as a therapeutic modality for stable vitiligo patches over these sites.
Nonsurgical Repigmentation Therapies in Vitiligo
Archives of Dermatology, 1998
To assess the effectiveness and safety of nonsurgical repigmentation therapies in localized and generalized vitiligo by means of a meta-analysis. Data Sources: Computerized searches of bibliographic databases, a complementary manual literature search, and contacts with researchers and pharmaceutical firms. Study Selection: Predefined selection criteria were applied to both randomized and nonrandomized controlled trials. Data Extraction: Two investigators independently assessed the articles for inclusion. When there was a disagreement, a third investigator was consulted. Data Synthesis: Sixty-three studies were found on therapies for localized vitiligo. Of these, 10 of 11 randomized controlled trials and 29 of 110 patient series were included. One hundred seventeen studies on therapies for generalized vitiligo were found. Of these, 10 of 22 randomized controlled trials and 46 of 231 patient series were included. Among randomized controlled trials on localized vitiligo, the pooled odds ratio vs placebo was significant for topical class 3 corticosteroids (14.32; 95% confidence interval [CI], 2.45-83.72). In the patient series, topical class 3 and class 4 corticosteroids carried the highest mean success rates (56% [95% CI, 50%-62%] and 55% [95% CI, 49%-61%], respectively). Side effects were reported mostly with topical psoralen and intralesional and class 4 corticosteroids. In the randomized controlled trials on generalized vitiligo, the odds ratio vs placebo was significant for oral methoxsalen plus sunlight (23.37; 95% CI, 1.33-409.93), oral psoralen plus sunlight (19.87; 95% CI, 2.37-166.32), and oral trioxsalen plus sunlight (3.75; 95% CI, 1.24-11.29). In the series, the highest mean success rates were achieved with narrowband UV-B (63%; 95% CI, 50%-76%), broadband UV-B (57%; 95% CI, 29%-82%), and oral methoxsalen plus UV-A therapy (51%; 95% CI, 46%-56%). Oral methoxsalen plus UV-A was associated with the highest rates of side effects. No side effects were reported with UV-B therapy. Conclusions: Class 3 corticosteroids and UV-B therapy are the most effective and safest therapies for localized and for generalized vitiligo, respectively.
Guidelines for the management of vitiligo
2016
Vitiligo is an acquired disorder of depigmentation affecting 0.1%-2% of the world’s population without discrimination of race, age and gender. The disease is characterized by white patches, often symmetrically distributed, which usually increase in size with time, corresponding to a considerable loss of functioning epidermal and sometimes hair follicle melanocyte. There are many treatment options available for the disease. Standardized guidelines for treating this disease in Asian skin are not readily available which leads to no set criteria for treating this cosmetically disfiguring problem. These guidelines have been prepared for dermatologists considering all the latest evidence based data available. Vitiligo is diagnosed clinically, although in some cases biopsy is required. Lesions on face and neck respond well to the treatment. However, segmental and acral types respond poorly to treatment. In the assessment of patient before starting therapy it is important to consider age, p...
Vitiligo: new and emerging treatments
Dermatologic Therapy, 2008
Vitiligo is a cosmetically disfiguring condition, and, although there is no therapeutic full solution yet, some treatment may induce good results in most patients. The disease can be successfully treated with various medical options. Both nonfocused or focused narrowband ultraviolet B phototherapy represents the current treatment of choice, to minimize side effects and reach optimal clinical results. Topical novel approaches are also considered. Surgical methods, consisting of autologous transplantation methods, is generally recommended for focal/stable vitiligo, after medical therapy has failed. Finally, for patients with extensive vitiligo, depigmentation of the residual melanin should be taken into account.
Repigmentation in vitiligo: position paper of the Vitiligo Global Issues Consensus Conference
Pigment Cell & Melanoma Research, 2017
The Vitiligo Global Issues Consensus Conference (VGICC), through an international e-Delphi consensus, concluded that "repigmentation" and "maintenance of gained repigmentation" are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation and the second summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over three years. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus. SIGNIFICANCE There is a need to clearly describe and define the various aspects of vitiligo repigmentation. The discussions at international meetings and e-surveys have sought to address both the issues of repigmentation and the maintenance of gained repigmentation.
Vitiligo: symptoms, pathogenesis and treatment
International journal of immunopathology and pharmacology
Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when then disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemo)therapy, surgery, combination therapies and depigmentation of normally pigmented skin. It seems that traditional Chinese medicine could be more effective than the current treatment for vitligo.