Surgical Interventions for Patients With Vitiligo JAMA Dermatology

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• In this systematic review and meta-analysis, the authors evaluated 117 studies involving surgical procedures used for patients with vitiligo: punch grafting (n = 19), thin skin grafting (n = 10), suction blister grafting (n = 29), noncultured epidermal cell suspension (n = 45), follicular cell suspension (n = 9), and cultured epidermal cell suspension (n = 17), encompassing a total of 8776 patients. Repigmentation >90%, >75%, and >50% by any surgical intervention was seen with 53%, 65%, and 81% of patients, respectively. The rate of repigmentation >90% was highest for thin skin grafting (72%) and suction blister grafting (62%) and was lowest for noncultured follicular cell suspension (36%).

• Surgical interventions for stable, refractory vitiligo provided substantial benefit in repigmentation for many patients. Rates of repigmentation as well as potential limitations and advantages vary by type of surgical procedure, so an individualized approach to select the best option is warranted. Successful repigmentation >90% was significantly associated with younger age, segmental disease, and nonacral locations, indicating that appropriate patient selection for surgical intervention is also important.

– Caroline K. Crabtree, MD

Abstract

IMPORTANCE

Surgical interventions are a key part of the therapeutic arsenal, especially in refractory and stable vitiligo. Comparison of treatment outcomes between the different surgical procedures and their respective adverse effects has not been adequately studied.

OBJECTIVE

To investigate the reported treatment response following different surgical modalities in patients with vitiligo.

DATA SOURCES

A comprehensive search of the MEDLINE, Embase, Web of Science, and Cochrane Library databases from the date of database inception to April 18, 2020, was conducted. The key search terms used were vitiligo, surgery, autologous, transplantation, punch, suction blister, and graft.

STUDY SELECTION

Of 1365 studies initially identified, the full texts of 358 articles were assessed for eligibility. A total of 117 studies were identified in which punch grafting (n = 19), thin skin grafting (n = 10), suction blister grafting (n = 29), noncultured epidermal cell suspension (n = 45), follicular cell suspension (n = 9), and cultured epidermal cell suspension (n = 17) were used.

DATA EXTRACTION AND SYNTHESIS

Three reviewers independently extracted data on study design, patients, intervention characteristics, and outcomes. Random effects meta-analyses using generic inverse-variance weighting were performed.

MAIN OUTCOMES AND MEASURES

The primary outcomes were the rates of greater than 90%, 75%, and 50% repigmentation response. These rates were calculated by dividing the number of participants in an individual study who showed the corresponding repigmentation by the total number of participants who completed the study. The secondary outcomes were the factors associated with treatment response to the surgical intervention.

RESULTS

Among the 117 unique studies and 8776 unique patients included in the analysis, rate of repigmentation of greater than 90% for surgical interventions was 52.69% (95% CI, 46.87%-58.50%) and 45.76% (95% CI, 30.67%-60.85%) for punch grafting, 72.08% (95% CI, 54.26%-89.89%) for thin skin grafting, 61.68% (95% CI, 47.44%-75.92%) for suction blister grafting, 47.51% (95% CI, 37.00%-58.03%) for noncultured epidermal cell suspension, 36.24% (95% CI, 18.92%-53.57%) for noncultured follicular cell suspension, and 56.82% (95% CI, 48.93%-64.71%) for cultured epidermal cell suspension. The rate of repigmentation of greater than 50% after any surgical intervention was 81.01% (95% CI, 78.18%-83.84%). In meta-regression analyses, the treatment response was associated with patient age (estimated slope, -1.1418), subtype of vitiligo (estimated slope, 0.3047), and anatomical sites (estimated slope, -0.4050).

CONCLUSIONS AND RELEVANCE

The findings of this systematic review and meta-analysis suggest that surgical intervention can be an effective option for refractory stable vitiligo. An appropriate procedure should be recommended based on patient age, site and size of the lesion, and costs.

JAMA Dermatology

Surgical Interventions for Patients With Vitiligo: A Systematic Review and Meta-analysis

JAMA Dermatol 2021 Feb 17;[EPub Ahead of Print], HJ Ju, JM Bae, RW Lee, SH Kim, D Parsad, A Pourang, I Hamzavi, J Shourick, K Ezzedine 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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