Delhi: Surgical intervention is a safe and effective option for the management of refractory stable vitiligo, finds a recent review in the journal JAMA Dermatology.
According to the authors, an appropriate procedure should be recommended based on costs, site and size of the lesion, and patient age.
Surgical interventions are an essential part of the therapeutic arsenal, especially in stable and refractory vitiligo. However, treatment outcomes comparison between the different surgical procedures and their respective adverse effects has not been studied adequately. Considering this, Hyun Jeong, The Catholic University of Korea, Seoul, and colleagues aimed to investigate the reported treatment response following different surgical modalities in patients with vitiligo.
For the purpose, the researchers conducted a comprehensive search of the online databases from the date of database inception to April 18, 2020
Of the 1365 identified studies, a total 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.
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.
Key findings of the study include:
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% and 45.76% for punch grafting, 72.08% for thin skin grafting, 61.68% for suction blister grafting, 47.51% for noncultured epidermal cell suspension, 36.24% for noncultured follicular cell suspension, and 56.82% for cultured epidermal cell suspension.
The rate of repigmentation of greater than 50% after any surgical intervention was 81.01%.
In meta-regression analyses, the treatment response was associated with patient age, subtype of vitiligo (estimated slope, 0.3047), and anatomical sites (estimated slope, −0.4050).
"These findings suggest that surgical intervention can be an effective and safe option for managing refractory stable vitiligo; selection of appropriate patients in terms of disease stability and suitable surgical procedure is important," concluded the authors.
The study titled, "Surgical Interventions for Patients With Vitiligo: A Systematic Review and Meta-analysis," is published in the journal JAMA Dermatology.
DOI: https://jamanetwork.com/journals/jamadermatology/article-abstract/2776177