Mechanical dermabrasion, CO2 laser led to positive results in epithelial sheet transplantation in vitiligo

In a self-administered study,¹ researchers found that both mechanical dermoblasticity and CO₂ Lasers have led to positive results in the transplantation of cultured epithelial sheets in vitiligo patients.

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Researchers Tang et al sought to compare the 2 methods of preparation at the recipient site, a vital part of vitiligo surgical treatment, and their abilities to achieve accurate removal prior to cultured epithelial sheet transplantation procedures. They noted that there is limited research in the dermatological landscape comparing these 2 methods in a side-by-side analysis.

The multicenter study (SHDC12016112), which was observer-blinded and prospective, included adult patients (n=120) aged between 18 and 65 years with stable vitiligo for whom other treatments were considered ineffective or ineffective. Patients who could not undergo such a procedure or who had a history or active case of serious medical, infectious or skin diseases were not eligible to participate.

The researchers collected full-thickness skin tissue from areas of normal pigmentation on the participants’ skin. The procedure involved either mechanical dermablasting or CO₂ lasering of areas affected by vitiligo lesions, with 2 comparable patches selected in each patient and treated in each corresponding manner. All sites were removed and covered with epithelial sheets, which were the previously harvested normally pigmented skin tissues cultured in defined keratinocyte serum-free medium and keratinocyte growth medium. Surgically treated lesions were covered with petroleum jelly-coated gauze and surgical tape and replaced 1 week after surgery. In addition, participants applied an antibiotic ointment to the treated sites twice daily.

At months 1, 3, 6, and 12 after treatment, patients returned for follow-up visits. Researchers looked at patient outcomes using digital photography and Wood’s lamp examination. Repigmentation rates, efficacy of different treatment modalities, and patient satisfaction were evaluated. The primary endpoint of the study was repigmentation rate, which was assessed on a scale from poor (<25%) to excellent (≥90%). Patient satisfaction was measured according to a 10-point visual analog scale.

One month after surgery, repigmentation rates equal to or greater than 50% were higher in dermoblastic (59.8%) than in CO₂ laser (54.4%). At months 3 and 6, repigmentation rates were slightly more comparable, with a 1% higher rate in CO₂ laser at 3 months and equal percentages at 6 months. At 12 months, however, CO₂ Laser had a slightly higher rate of re-pigmentation (79.07%) than dermoplasty (77.91%).

Additionally, while both methods showed a statistical difference in their overall outcome, the researchers observed a trend toward better efficacy in dermabrasion based on higher repair rates of neck lesions. For facial and extremity acne lesions, the recovery rate with CO2 laser was higher than that of dermabrasion.

Adverse effects included mild hyperplasia, mild exudation, and hyperpigmentation. These reactions faded over time or improved with topical treatments.

“The two methods have different preferred applications and no significant difference in ultimate efficacy was noted,” wrote study authors Tang et al. “Given that our study has some limitations, a larger sample size was needed to further elucidate the association between vitiligo subtype or lesion size and ablation methods and to establish an evidence-based selection of ablation for site preparation of the recipient”.

Report

1. Tang L, Luo Z, Li J, et al. Comparison of mechanical dermabrasion and CO₂ Laser transplantation of cultured epithelial sheets in the treatment of refractory stable vitiligo: a multicenter, prospective, and self-controlled comparative study. JEADV Clin Pract. Published online on August 24, 2023. doi:10.1002/jvc2.241