Erbium:YAG laser and cultured epidermis in the surgical therapy of stable vitiligo.
OBJECTIVE
To induce complete and reproducible repigmentation of large "stable" vitiligo lesions by means of autologous cultured epidermal grafts using a rapid, simple, and minimally invasive surgical procedure.


METHODS
Achromic epidermis was removed by means of appropriately settled erbium:YAG laser, and autologous epidermal grafts were applied onto the recipient bed. Melanocyte content was evaluated by dopa reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system.


METHODS
A biosafety level 3-type cell culture facility, a surgical ambulatory department, and a dermatological department in a hospital.


METHODS
Twenty-one patients with different types of vitiligo were admitted to the study and treated with autologous cultured epidermal grafts. Inclusion criteria were failure of at least 2 standard medical approaches; no therapy for at least 12 months; no progression of old lesions or appearance of new lesions; no Koebner phenomenon within the past 18 months; and no autoimmune disorders.


RESULTS
The average percentage of repigmentation in 21 patients was 75.9% (1759.7 cm2 repigmented/2315.8 cm2 transplanted). Three patients showed a reactivation of their vitiligo and did not show repigmentation. The remaining 18 patients, with 43 distinct lesions, showed an average percentage of repigmentation of 90% (1759.7 cm2 repigmented/1953.4 cm2 transplanted).


CONCLUSIONS
Under appropriate conditions, cultured epidermal grafts induce complete repigmentation of stable vitiligo lesions. Erbium:YAG laser surgery can supply a fast and precise tool for disepithelialization, hence allowing treatment of large vitiligo lesions during a single surgical operation.
Laboratory of Tissue Engineering, Istituto Dermopatico dell'Immacolata, Rome, Italy.
Liliana
L
Guerra
Grazia
G
Primavera
Desanka
D
Raskovic
Graziella
G
Pellegrini
Osvaldo
O
Golisano
Sergio
S
Bondanza
Patrizia
P
Paterna
Giulio
G
Sonego
Tommaso
T
Gobello
Francesco
F
Atzori
Paolo
P
Piazza
Antonio
A
Luci
Michele
M
De Luca
D000293:Adolescent; D000328:Adult; D002478:Cells, Cultured; D004817:Epidermis / Q000473:pathology / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014820:Vitiligo / Q000473:pathology / Q000601:surgery*