Long-term results of 2-mm punch grafting in patients with vitiligo vulgaris and segmental vitiligo: effect of disease activity.
BACKGROUND
Punch grafting is a simple and frequently used technique for the treatment of stable vitiligo, resistant to medical therapy. However, studies reporting long-term results are exceptional.


OBJECTIVE
To evaluate the long-term results of 2-mm punch grafting in patients with vitiligo vulgaris and segmental vitiligo.


METHODS
We studied a prospective cohort study involving 61 patients (25 male, 36 female) with vitiligo vulgaris and nine patients (all male) with segmental vitiligo who underwent 2-mm punch grafting more than 3 years ago. The main outcome measure was the degree of repigmentation of a single transplanted lesion as measured with a digital image analysis system with a mean follow-up of 5.2 years.


RESULTS
In patients with vitiligo vulgaris, 17 lesions (28%) showed excellent, 14 lesions (23%) showed good, 14 lesions (23%) showed fair and 16 lesions (26%) showed poor repigmentation. In patients with segmental vitiligo, seven of nine lesions (78%) showed excellent repigmentation. A cobblestone-like effect was observed in 19 of 70 patients (27%). Disease activity after punch grafting was reported in 94% of patients with poor repigmentation but in only 18% of patients with excellent repigmentation (chi(2) test, P < 0.0005). Patients who reported disease activity after transplantation had a lower mean repigmentation than those who did not report disease activity (77% vs. 39%, P < 0.05).


CONCLUSIONS
Two-millimetre punch grafting in vitiligo is an effective surgical procedure with long-lasting effect. To prevent a cobblestone-like effect, we advise the use of smaller grafts (1-1.2 mm). Disease activity after grafting, localization and type of vitiligo, prior ultraviolet B treatment and a Koebnerized donor site influence the long-term outcome of punch grafting and should be taken into account in the selection of patients eligible for this treatment.
Fongers
A
A
Netherlands Institute for Pigment Disorders, 1105 AZ Amsterdam, The Netherlands.
Wolkerstorfer
A
A
Nieuweboer-Krobotova
L
L
Krawczyk
P
P
Tóth
G G
GG
van der Veen
J P W
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012880:Skin Pigmentation; D016038:Skin Transplantation / Q000379:methods*; D013057:Spectrum Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014820:Vitiligo / Q000473:pathology / Q000601:surgery*; D055815:Young Adult