Efficacy of 1-mm minigrafts in treating vitiligo depends on patient age, disease site and vitiligo subtype

Abstract

Vitiligo vulgaris is a refractory skin disease. Treatment modalities include topical steroids, phototherapy, suction blister roof grafts and cellular grafting techniques. Adverse effects may occur, however, and some cases remain unresponsive to treatment. To evaluate the efficacy of small (1-mm) punch minigraft therapy in relation to patient age, disease site, disease duration and vitiligo subtype. We used a recently developed disposable 1.0-mm punch apparatus to perform minigraft therapy in 20 patients with either generalized (n = 4), segmental (n = 9) or limited (n = 7) vitiligo, and evaluated the area and rate of repigmentation in relation to patient age, disease site, disease duration and vitiligo subtype. The area of repigmentation was significantly greater in patients with segmental vitiligo (n = 9) than in those with generalized vitiligo (n = 4). Repigmentation covered a broader area and occurred more quickly in patients under 15 years of age than in those over 20 years of age (n = 9). Disease duration did not affect the repigmentation rate. The results of the present study suggest that 1-mm minigrafts are effective for treating patients with vitiligo. Better results occurred in patients under 15 years of age, patients with facial grafts, and patients with segmental and limited subtypes.

Successful Treatment of Segmental Vitiligo in Children with the Combination of 1-mm Minigrafts and Phototherapy

“…In contrast, Babu et al [15] and Feetham et al [16] performed 1.5-mm minigrafting in 8 and 30 patients, respectively, and they did not report any significant adverse effects, such as cobblestone appearance. Kato et al [9] have recently reported the results of their performance of the safer 1-mm minigrafting procedure in 20 patients. Repigmentation of ≥76% was obtained in 10 patients, of 51-75% in 1 patient and of ≤50% in 9 patients.…”

“…Minigrafting is well indicated for localized and segmental vitiligo, and it is particularly recommended for use in facial vitiligo [9]. We performed grafting with 1-mm minigrafts and postoperative phototherapy in 13 patients aged <16 years with segmental vitiligo and obtained high mean repigmentation of 81.6% overall.…”

“…In an examination of the therapeutic effect of minigrafting according to age, Kato et al [9] reported that it was more effective in patients aged ≤15 years than in patients aged ≥20 years. Our results suggest that greater effectiveness can be obtained by performing the treatment at a younger age, ≤12 years.…”

“…Therefore, minigrafting using smaller grafts was then attempted. It is now thought that grafts ≥1.5 mm in size are prone to conditions such as cobblestone or polka dot appearance or scar formation as postoperative adverse effects [8,9,10]. Consequently, minigrafting using grafts of 1.0-1.2 mm in size has been widely adopted [9,10,11].…”

“…Segmental vitiligo occurs unilaterally and is considered a good indication for surgical treatment [9]. Recently, the combined use of phototherapy after skin grafting has become common to facilitate pigment spread after minigrafting [8,12].…”