Characterization of Clinical Response in Patients with Vitiligo Undergoing Autologous Epidermal Punch Grafting

Author Interview: Amit G. Pandya, MD

Professor
Department of Dermatology
University of Texas Southwestern Medical Center
Dallas, Texas

What are the main findings of the study? 

THIS STUDY SHOWS THAT PUNCH GRAFTS:

• ARE EASY TO DO AND RESULT IN GOOD SURVIVAL FOR MOST PATIENTS.
• YOUNGER PATIENTS RESPOND BETTER THAN OLDER PATIENTS.
• GRAFTING OF THE NECK AND TRUNK RESPONDS BETTER THAN ACRAL LOCATIONS AND SKIN OVER JOINTS.
• COMPLIANCE WITH PHOTOTHERAPY WAS IMPORTANT IN ACHIEVING A GOOD RESULT.

Were any of the findings unexpected? 

WE EXPECTED THE FACE TO DO THE BEST BUT THIS WASN’T THE CASE, PERHAPS BECAUSE IT WAS A SMALL STUDY.

What should clinicians and patients take away from this study? 

PUNCH GRAFTING CAN BE DONE BY ANY DERMATOLOGIST WITHOUT VERY MUCH DIFFICULTY.

THE RESULTS ARE GOOD, ESPECIALLY FOR SMALL AREAS.

SEGMENTAL VITILIGO OF SMALL AREAS IS ESPECIALLY AMENABLE TO THIS TREATMENT.

OUR PAPER DESCRIBES HOW TO PERFORM THESE EASY GRAFTS. COBBLESTONING DOES OCCUR, BUT PATIENTS ARE USUALLY NOT BOTHERED BY IT BECAUSE THE GRAFTS ARE SO SMALL (1.5 MM). DISPOSABLE 1.5 MM PUNCHES ARE READILY AVAILABLE.

What recommendations do you have for future research as a result of your study? 

• THE RELATIVE UTILITY OF NBUVB OVER PUVA SHOULD BE ASSESSED IN FUTURE STUDIES.
• FUTURE STUDIES SHOULD BE PROSPECTIVE, WITH A LARGER SAMPLE SIZE IN ORDER TO OBTAIN BETTER EVIDENCE.
• FUTURE STUDIES SHOULD ALSO INCLUDE CONTROLS AND OBJECTIVE OUTCOME MEASURES AND DETERMINE THE UTILITY OF ADJUVANT TOPICAL TREATMENTS AND PHOTOTHERAPY AFTER GRAFTING.

Reference:

Characterization of Clinical Response in Patients with Vitiligo Undergoing Autologous Epidermal Punch Grafting

Hattie Jill Feetham BS, Joanna L. Chan MD, Amit G. Pandya MD

Dermatologic Surgery
Volume 38, Issue 1, pages 14–19, January 2012
DOI: 10.1111/j.1524-4725.2011.02171.x