Both modalities achieved positive results and accurate ablation in cultured epithelial sheets transplantation for patients with vitiligo.
In a self-controlled study,1 investigators found that both mechanical dermablasion and CO2 lasers led to positive results in cultured epithelial sheets transplantation for patients with vitiligo.
Investigators Tang et al sought to compare the 2 modalities of recipient-site preparation, a vital part of surgical treatment of vitiligo, and their abilities to achieve accurate ablation prior to cultured epithelial sheets transplantation procedures. They noted that there is limited research in the dermatology landscape comparing these 2 modalities in a side-by-side analysis.
The multicenter study (SHDC12016112), which was observer-blinded and prospective in nature, included adult patients (n=120) between the ages of 18 and 65 years of age with stable vitiligo for whom other treatments were deemed ineffective or invalid. Patients unable to undergo such a procedure or who had a history of or active case of serious medical diseases, infectious diseases, or cicatricial diseases, were ineligible to participate.
Investigators collected full-thickness skin tissue from normally-pigmented sites on the participants’ skin. The procedure consisted of either mechanical dermablasionor CO2 lasering of areas affected by vitiligo lesions, with 2 comparable patches selected on each patient and treated with each respective modality. All sites were ablated and covered with epithelial sheets, which were the previously collected normally-pigmented skin tissues that had been cultured in a defined keratinocyte serum-free medium and keratinocyte growth medium. Surgically-treated lesions were covered in Vaseline-coated gauze and surgical tape and replaced 1 week after surgery; additionally, participants applied an antibiotic ointment to the treated sites on a twice-daily basis.
At months 1, 3, 6, and 12 after treatment, patients returned for follow-up visits. Investigators examined patient outcomes using digital photography and Wood’s lamp examination. Rates of repigmentation, efficacy of different treatment modalities, and patient satisfaction were evaluated. The study’s primary endpoint rate of repigmentation, which was evaluated on a scale of poor (<25%) to excellent (≥90%). Patient satisfaction was measured in accordance witha 10-point Visual Analog Scale.
One month after surgery, rates of repigmentation equal to or greater than 50% were higher in dermablasion (59.8%) than in the CO2 laser (54.4%). At months 3 and 6, rates of repigmentation were slightly more comparable, with a 1% higher rate in the CO2 laser at 3 months and equal rates at 6 months. At 12 months, however, the CO2 laser had a slightly higher rate of repigmentation (79.07%) than dermablasion (77.91%).
Furthermore, while both methods did demonstrate a statistical difference in their overall effect, investigators noted a trend of better efficacy in dermabrasion based on higher rates of recovery of lesions of the neck. Regarding facial and acral lesions, the CO2 laser recovery rate was higher than that of dermabrasion.
Adverse reactions included mild hyperplasia, mild exudation, and hyperpigmentation. These reactions faded over time or improved with the assistance of topical treatments.
“The two methods have different preferred applications and no significant difference was noted in final efficacy,” wrote study authors Tang et al. “Since our study has some limits, the larger sample size was needed to further clarify the association between the subtype of vitiligo or lesion size and ablation methods, and to establish an evidence-based selection of ablation for recipient site preparation.”
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