Efficacy of suction blister epidermal grafting with concomitant phototherapy in vitiligo treatment

Abstract

A b s t r a c tIntroduction: 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.

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).…”

“…In punch grafting, cobblestone appearance, milia, and color mismatch were the most common and critical adverse events . In suction blister grafting, perigraft halo, variegated appearance, and color mismatch were frequently reported . Thin skin grafting was associated with graft contracture, overhanging margin, wrinkles over the graft surface, and perigraft halo .…”

Vitiligo. Diagnostic and therapeutic recommendations of the Polish Dermatological Society

“…Dostępne obecnie metody obejmują: leczenie miejscowe, ogólne, fototerapię, laseroterapię, metody chirurgiczne, kosmetyczne, leczenie wspomagające oraz psychoterapię. W wielu publikacjach opisywano terapie łączone z wykorzystaniem fototerapii oraz innych form leczenia w celu przyspieszenia procesu repigmentacji [18][19][20]. Repigmentację ognisk chorobowych można uzyskać, wywołując migrację melanocytów z mieszków włosowych (repigmentacja przymieszkowa) bądź rzadziej z obwodu odbarwienia (repigmentacja obwodowa) [3,21], Należy pamiętać, że większość leków używanych w terapii bielactwa nabytego jest stosowana poza wskazaniami rejestracyjnymi (off-label), co należy uwzględnić w dokumentacji chorych i postępować zgodnie z obowiązującymi w tym zakresie przepisami.…”

Study on the Use of Microbial Cellulose as a Biocarrier for 1,3-Dihydroxy-2-Propanone and Its Potential Application in Industry

“…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 [ 30 ]. There are some modifications of this method such as SBEG with CO 2 laser ablation which offers simple and safe treatment of vitiligo, especially for patients with small and stable vitiliginous lesions [ 31 ].…”