028 Is suction blister epidermal grafting a simple and reliable way to screen patients with large area vitiligo for ReCell treatment?

Abstract

The objective of the present randomized, double-blind trial was to evaluate the efficacy and safety of daily topical washing procedure with miconazole nitrate-containing soap for candidiasis at diaper-covered sites in elderly subjects under long-term inpatient care. We initially enrolled 75 elderly patients with a constant use of diapers, and of this cohort, 55 patients (32 male and 23 female) who randomly assigned to receive treatment with either miconazole soap (n¼28) or miconazole-free placebo soap (n¼27) were assessed microscopically for the existence of the pseudohyphae and/or blastoconidia of Candida spp. up to 4 weeks. Although washing with miconazole soap did not affect the baseline frequency of pseudohyphae/blastoconidia-positive patients, it significantly inhibited the positive conversion of pseudohyphae/blastoconidia compared with the placebo group (17.3% vs. 44.0%, respectively; p<0.05). Moreover, the frequency of patients positive for pseudohyphae/blastoconidia at 4 week was significantly lower in the miconazole group than in the control group (17.9% vs. 44.4%, respectively; p<0.01). These anti-Candida effects were not different between both sexes, and neither clinically-apparent diaper candidiasis nor severe adverse effects developed in either group. Patients with diarrhea and heart failure tended to be associated with the positive rate of pseudohyphae/blastoconidia. A daily washing with miconazole soap is easy and quick to perform, as a paramedical stuff work, and well-tolerated for anogenital skin in elderly. This prophylactic approach can inhibit the progressive conversion activity of genital Candida flora, enabling to maintain satisfactory genital hygiene in patients wearing diapers.

Surgical Interventions for Patients With Vitiligo

“…We analyzed a total of 117 unique studies with 8776 unique patients (eTable 1 in the Supplement), including 19 studies with 1631 patients in the punch grafting group, 10 studies with 718 patients in the thin skin grafting group, 29 studies with 2652 patients in the suction blister grafting group, 45 studies with 2209 patients in the noncultured epidermal cell suspension (NCES) group, 9 studies with 185 patients in the noncultured follicular cell suspension (NCFS) group, and 17 studies with 1381 patients in the cultured epidermal cell suspension (CES) group; 11 studies included more than 1 procedure type. The median follow-up duration was 7 (range, 2-108) months.…”

“…Overall, the rate of repigmentation achieved by patients after 1 session of any surgical intervention included greater than 90% in 52.69% (95% CI, 46.87%-58.50%) in 106 studies with 6586 patients ( I 2 = 97.2%) (eFigure 2 in the Supplement); greater than 75% in 64.72% (95% CI, 59.52%-69.92%) in 100 studies with 3400 patients ( I 2 = 95.7%); and greater than 50% in 81.01% (95% CI, 78.18%-83.84%) in 92 studies with 5462 patients ( I 2 = 90.7%). According to the surgical intervention type, greater than 90% repigmentation was achieved in 72.08% (95% CI, 54.26%-89.89%) of patients undergoing thin skin grafting (670 patients in 8 studies), 61.68% (95% CI, 47.44%-75.92%) of patients undergoing suction blister grafting (2349 patients in 21 studies), 56.82% (95% CI, 48.93%-64.71%) of patients undergoing CES (1138 patients in 14 studies), 47.51% (95% CI, 37.00%-58.03%) of patients undergoing NCES (907 patients in 29 studies), 45.76% (95% CI, 30.67%-60.85%) of patients undergoing punch grafting (1354 patients in 11 studies), and 36.24% (95% CI, 18.92%-53.57%) of patients undergoing NCFS (160 patients in 8 studies) after 1 session of each surgery (eFigure 2 in the Supplement and Table 1). In our meta-regression analysis, for greater than 90% repigmentation, the estimate of the slopes for mean age of patients was −1.1418 ( P = .02); for the proportion of segmental vitiligo, 0.3047 ( P = .01); and for the proportion of treated lesions on the acral and joint areas, −0.4050 ( P = .002) (Figure 2).…”