Surgical intervention may yield adequate repigmentation rate in refractory stable vitiligo
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More than half of patients undergoing surgical procedures for refractory stable vitiligo experienced more than 90% repigmentation, according to a study.
“Surgical interventions are a key part of the therapeutic arsenal, especially in refractory and stable vitiligo,” Hyun Jeong Ju, MD, of the department of dermatology at St. Vincent’s Hospital, College of Medicine, at the Catholic University of Korea, and colleagues wrote. “Comparison of treatment outcomes between the different surgical procedures and their respective adverse effects has not been adequately studied.”
Using a comprehensive search of Medline, Embase, Web of Science and Cochrane Library databases, the researchers aimed to assess treatment responses to various surgical modalities. The search initially yielded 1,365 studies from database inception through April 18, 2020.
Ultimately, 8,776 unique patients from 117 studies involving punch grafting (n=19 studies), thin skin grafting (n=10), suction blister grafting (n=29), non-cultured epidermal cell suspension (n=45), follicular cell suspension (n=9) and cultured epidermal cell suspension (n=17) were included; 11 studies involved more than one procedure.
Repigmentation response greater than 90%, 75% and 50% served as the primary endpoint. The researchers also assessed for factors associated with response to the surgical intervention.
Results showed that a repigmentation rate of 90% occurred in 52.69% (95% CI, 46.87%-58.50%) of surgical interventions overall. A repigmentation rate of more than 75% occurred in 64.72% (95% CI, 59.52%-69.92%) of patients undergoing any surgical intervention, while a repigmentation rate of greater than 50% occurred in 81.01% (95% CI, 78.18%-83.84%) of patients undergoing any surgery.
Looking at specific procedures, a 90% repigmentation rate was reported in 45.76% (95% CI, 30.67%-60.85%) of patients undergoing punch grafting, 72.08% (95% CI, 54.26%-89.89%) for those treated with thin skin grafting, 61.68% (95% CI, 47.44%-75.92%) in suction blister grafting, 47.51% (95% CI, 37.00%-58.03%) in non-cultured epidermal cell suspension, 36.24% (95% CI, 18.92%-53.57%) for non-cultured follicular cell suspension and 56.82% (95% CI, 48.93%-64.71%) for cultured epidermal cell suspension.
Regression analysis results showed associations between treatment response and several factors, including patient age (estimated slope, 1.1418), subtype of vitiligo (estimated slope, 0.3047) and anatomical sites (estimated slope, 0.4050).
“The findings of this systematic review and meta-analysis suggest that surgical intervention can be an effective option for refractory stable vitiligo,” the researchers wrote. “An appropriate procedure should be recommended based on patient age, site and size of the lesion, and costs.”
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