Carbon Dioxide Laser Resurfacing and Thin Skin Grafting in the Treatment of “Stable and Recalcitrant” Vitiligo

Abstract

Various surgical methods have been used in the treatment of small stable vitiliginous areas, but there is no established surgical approach for larger vitiligo areas and therapy-resistant anatomic sites, such as the hands. Two years ago, we successfully treated large burn scar depigmentation areas at different anatomic sites using carbon dioxide laser resurfacing and thin (0.2 to 0.3 mm) skin grafting. The purpose of this study was to investigate the effectiveness of our method in treating large, stable, and recalcitrant vitiligo areas. Thirteen anatomic sites of seven male patients, whose ages ranged from 20 to 22 years, were treated. The locations of the treated areas were as follows: seven areas on the dorsum of the hands, two areas on the forearms, two areas in the pretibial region, one area on the lateral thigh, and one area in the presternal region. The surface area of treated vitiligo sites ranged from 0.5 to 6 percent of total body surface area (mean, 2.5 percent). Skin graft take was excellent in all patients except for one. The follow-up period for these patients ranged from 6 to 18 months, with an average follow-up period of 14 months. Early and complete repigmentation was achieved and the color match was good or excellent in all patients. No depigmentation occurred again in the treated areas or graft donor sites. In conclusion, with careful patient selection and delicate surgical technique, our method was effective in treating large areas of vitiligo over the extremities and dorsum of hands, which were refractory to other therapies and could not be hidden.

Combined Excimer Laser and Topical Tacrolimus for the Treatment of Vitiligo: A Pilot Study

“…Tacrolimus ointment was also well tolerated in the axillary and periocular areas. All subjects were previously refractory to treatment, and six of eight subjects had vitiligo for over 5 years, reinforcing previous reports that there is no relationship between duration of disease, progression, and therapeutic result 21 …”

Vitiligo: A comprehensive overview

“…It is then meshed to prevent seroma formation and to cover a greater surface area, placed over a dermabraded recipient site, and dressed in gauze. 143 Efficacy. Agrawal et al 144 treated 32 sites in 21 patients with stable refractory vitiligo using this technique.…”

Erbium:YAG Laser and Cultured Epidermis in the Surgical Therapy of Stable Vitiligo

“…Among the different known disepithelialization procedures, 4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19] we chose laser technology. Among the multiple laser-based techniques available, erbium:YAG (Er:YAG) lasers [12][13][14][15] and carbon dioxide lasers [16][17][18][19] have been used to remove theepidermisinthesurgicaltreatmentofvitiligo with either conventional procedures [12][13][14][15][16][17] or with pure melanocyte cultures. 18,19 The Er:YAG laser was introduced into laser resurfacing procedures as an alternative to carbon dioxide laser surgery in the hope of maintaining clinical benefits and decreasing adverse effects.…”