Site Preparation Methods for the Surgical Treatment of Vitiligo
Multiple effective methods for recipient site preparation in patients undergoing surgical vitiligo treatment were outlined in study data published in Dermatologic Therapy. In a randomized clinical trial of patients undergoing noncultured epidermal cell suspension (NCES) for vitiligo, site preparation with dermabrasion or cryoblister techniques was associated with good repigmentation outcomes and high patient satisfaction. Preparation with dermaroller had poor repigmentation compared with the other techniques.
Although NCES is a well-established form of vitiligo treatment, the optimal method of recipient site preparation remains unclear. To compare the relative efficacies of common preparation methods, investigators recruited patients with vitiligo from a dermatology clinic in Chandigarh, India, from June 2018 to June 2019. Patients with at least 3 vitiligo patches in the same anatomic region who had elected to undergo NCES were enrolled.
Patients underwent 3 site preparation methods on at least 3 separate lesions prior to NCES: dermabrasion, cryoblister, and dermaroller. After NCES, participants were followed up at 4, 8 and, 12 weeks post-procedure. The primary outcomes were site repigmentation, color match, and patient satisfaction.
The study cohort comprised 36 patients, of whom 22 were women. Mean age at enrollment was 28.33 (±9.4) years; mean disease duration was 10.06 (±5.3) years. Mean surface area treated per patient was comparable among the 3 preparation methods: 3.7 (±1.4) cm2 with dermabrasion; 3.5 (±1.2) cm2 with cryoblister; and 3.1 (±1.4) cm2 with dermaroller.
At 12 weeks, dermabrasion and cryoblister had comparable efficacy with respect to extent of repigmentation. Specifically, 55.6% and 47.2% of lesions treated with dermabrasion and cryoblister had achieved more than 75% repigmentation, respectively (P =.63). In addition, patient satisfaction score was similar for lesions treated with dermabrasion and lesions treated with cryoblister (20.2± 9.6 vs 19.9±7.9 out of 30.0; P =.194).
However, dermabrasion had superior rapidity (65% vs 32.5% repigmentation at 4 weeks; P =.04) and color match (47.2% vs 19.4%; P =.004) compared with cryoblister.Also,, hyperpigmentation was observed in 72.2% of patches treated with cryoblister, compared with just 33.3% of patches with dermabrasion.
Dermaroller had poor repigmentation, rapidity, and color match outcomes compared with both dermabrasion and cryoblister.
Based on these results, cryoblister and dermabrasion appear equally effective NCES preparation methods with respect to repigmentation and patient satisfaction. However, cryoblister was associated with higher risk for repigmentation. Dermaroller had inferior outcomes compared with the other 2 methods.
As study limitations, investigators cited the small sample size and short follow-up period. Further research is needed to better clarify the outcomes of various recipient site preparation methods.
“This study established both dermabrasion and cryoblister as equally efficacious techniques of preparing vitiligo patches prior to NCES, producing rapid repigmentation (<12 weeks) with good color match even in difficult-to-treat areas,” investigators wrote. “Hence, in stable vitiligo patients, both dermabrasion and cryoblister can be used to prepare recipient sites in NCES.”
Reference
Subburaj K, Thakur V, Kumaran MS, Vinay K, Srivastava N, Parsad D. A prospective, randomized clinical study to compare the efficacy of recipient site preparation using dermabrasion, cryoblister, and dermaroller in autologous noncultured epidermal cell suspension in stable vitiligo. Published online December 19, 2020. Dermatol Ther. doi:10.1111/dth.14683