Therapy-resistant vitiligo; treatment with autologous epidermal grafting using the tops of suction blisters-modified technique

ABSTRACT

Current treatment of vitiligo has been disappointing. In this study, emphasis was placed on treating the most refractory types of vitiligo, namely the segmental and focal varieties, none of which had responded satisfactorily to topical corticosteroids and topical or systemic psoraien and exposure to ultraviolet tight. [PUVA therapy]. Autologous epidermal grafting using the tops of suction blisters was the offered treatment to those resistant cases. Suction Mister epidermal grafting is a useful modality for treatment of resistant and stable vitiligo; however, the original apparatus is expensive one. This study attempts to develop a cheap and small apparatus, which can be assembled in the physician's, own office. Prospective study. National Hepatoiogy and Tropical Medicine Research Institute [NHTMR 1]. Twenty patients with therapy-resistant segmental or focal type of vitiligo were treated with autologous epidermal grafting using the tops of suction blisters. The epidermis was separated from underlying dermis by vacuum suction on the donor area. On the recipient area, similar blisters were raised by freezing of the skin. The busier roof induced by suction was removed and transplanted to the blister bed prepared on the depigmented area. The ventose machine used in obstetric delivery was connected to aluminum cups especially designed for that purpose and applied to obtain the suction blisters from the donor area. Ten parents exhibited almost complete repigmentation / [80%-100% improvement] at the grafted site within I to 3 months, in two patients a 70% response was achieved, while another faur patients did not respond to the treatment. Four patients lost follow up. Repigmentation that was noted in the recipient areas was retained at 1.5 years follow up. The donor areas healed well, with minimal hyperpigmentatian in most, of the cases. No unwanted effects were met with cases treated. Our results suggest that autologous epidermal grafting using the tops of suction blisters is a good treatment for the [therapy-resistant] segmental and/or focal type of vitiligo. Epidermal grafting leaves no scarring at all. The technique appears to be safe, simple, and effective. Introducing this simple suction device made the procedure also cheap and suitable to be applied on outpatient bases in our community in Egypt