Erbium:YAG laser and cultured epidermis in the surgical therapy of stable vitiligo

Objective: To induce complete and reproducible repigmentation of large "stable" vitiligo lesions by means of autologous cultured epidermal grafts using a rapid, simple, and minimally invasive surgical procedure. Design: Achromic epidermis was removed by means of appropriately settled erbium:YAG laser, and autologous epidermal grafts were applied onto the recipient bed. Melanocyte content was evaluated by dopa reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system. Setting: A biosafety level 3-type cell culture facility, a surgical ambulatory department, and a dermatological department in a hospital. Patients: Twenty-one patients with different types of vitiligo were admitted to the study and treated with autologous cultured epidermal grafts. inclusion criteria were failure of at least 2 standard medical approaches; no therapy for at least 12 months; no progression of old lesions or appearance of new lesions; no Koebner phenomenon within the past 18 months; and no autoimmune disorders. Results: The average percentage of repigmentation in 21 patients was 75.9% (1759.7 cm(2) repigmented/2315.8 cm 2 transplanted). Three patients showed a reactivation of their vitiligo and did not show repigmentation. The remaining 18 patients, with 43 distinct lesions, showed an average percentage of repigmentation of 90% (1759.7 cm(2) repigmented/1953.4 cm(2) transplanted). Conclusions: Under appropriate conditions, cultured epidermal grafts induce complete repigmentation of stable vitiligo lesions. Erbium:YAG laser surgery can supply a fast and precise tool for disepithelialization, hence allowing treatment of large vitiligo lesions during a single surgical operation.