Quantitative Outcome Assessment of Color Match and the Extent of Repigmentation after Pixel Array Epidermal Grafting for Head and Neck Stable Vitiligo: A Prospective Cohort Study

Abstract

Background: Epidermal grafting with an automatic harvesting system has been reported as a simple and efficacious procedure for stable vitiligo. However, no prospective cohort study has quantitatively evaluated the color matching and extent of repigmentation in the head and neck area by this method. Objective: To evaluate the color matching and extent of repigmentation after pixel array epidermal grafting by image analysis software and physicians’ naked eye. Methods: Ten Asian patients with head and neck vitiligo lesions stable for at least 6 months were treated with pixel array epidermal grafting with an automatic harvesting system and post-grafting phototherapy. The patients were evaluated 1, 3, and 6 months post grafting for the percentage of repigmentation by blinded physicians’ assessment and image analysis software. The color matching index of repigmentation was evaluated by measuring the melanin index in the grafted area and the juxta non-vitiliginous area. Results: The average blister harvest time was 46.3 ± 9.7 min. The area percentile of repigmentation by the image analysis software were 32.3 ± 26.8, 64.6 ± 29.4, and 76.5 ± 25.9 at 1, 3, and 6 months post grafting, respectively. There were no significant differences between the physicians’ assessments and the results from the image analysis software. The change in the area percentile of repigmentation between 3 and 6 months post grafting was only statistically significant using image analysis software. The grafted area achieved a color match of 83.1 ± 13.4% that of the juxta non-vitiliginous area 6 months after grafting. Three patients had repigmentation of leukotrichia. Conclusion: By quantitative measurement, uniform pixel array micrografts provide a very good extent of repigmentation and color match in the head and neck area. Image analysis software revealed a steady increase in repigmentation after POM3 until POM6, which was not detected by subjective assessment.

Assessment of changes in color and size of vitiligo lesions during treatment with narrow band ultraviolet B

“…4 patients showed poor response in group B. In our study, 82.5% of lesions showed excellent results, this may be due to the longer duration of phototherapy and larger accumulative dose, also we had 4 lesions showing expansion as contrary to Bilal et al 11 where they reported no worsening in any lesions, this may be due to small sample size in both our studies, also the study conducted by Bilal et al 10 did not mention the number of treated lesions.…”

“…Another study evaluated the color matching and extent of repigmentation after pixel array epidermal grafting by image analysis software and physicians’ naked eye and concluded that image analysis software revealed a steady increase in repigmentation after POM3 until POM6, which was not detected by subjective assessment 10 …”

Transplantation procedures in vitiligo: What's new

“…Although it has the advantage of greater yield of graft area, quicker procedure, and lesser risk of donor site scarring, it fared inferior to manual suction blister grafting at sites such as the bony prominences, lips, and eyelids 10 . However, the pixel array micrografting boasts superior color matching, as seconded by imaging software 11 …”

Adaptability of melanocytes post ultraviolet stimulation in patients with melasma

“…7,8 Recent studies have used mexameter for objective melanin measurement. 9 Furthermore, reflectance confocal microscopy (RCM), harmonic generation microscopy, and cellular resolution full-field optical coherence tomography (CRFF-OCT) system allow visualization of skin in real time at almost histologic resolution. [10][11][12] Nevertheless, in vivo observation of human skin melanin, quantitative measurement of the amount and intensity of melanin, and analysis of the distribution of melanin in different skin layers remain scarce.…”

“…Melasma lesions are often extensive with heterogeneous pathological findings, and noninvasive assessment is warranted 7,8 . Recent studies have used mexameter for objective melanin measurement 9 . Furthermore, reflectance confocal microscopy (RCM), harmonic generation microscopy, and cellular resolution full‐field optical coherence tomography (CRFF‐OCT) system allow visualization of skin in real time at almost histologic resolution 10–12 .…”