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The minigrafting test for vitiligo: Validation of a predicting tool

2004; Elsevier BV; Volume: 51; Issue: 4 Linguagem: Inglês

10.1016/j.jaad.2003.11.085

1097-6787

Rafael Falabella,

RNA regulation and disease

To the Editor: Our 1995 study1.Falabella R. Arrunategui A. Barona M.I. Alzate A. The minigrafting test for vitiligo: Detection of stable lesions for melanocyte transplantation.J Am Acad Dermatol. 1995; 33: 1061-1062Abstract Full Text PDF PubMed Google Scholar consisted of implanting 4 to 6 punch minigrafts of 1.0 mm to 1.2 mm within achromic vitiligo lesions to evaluate pigment spread around minigrafts and anticipate the results of surgical repair. In those 47 patients, we found that 95% of patients with unilateral (segmental/focal) vitiligo tested positive, indicating high possibilities of repigmentation success, whereas only 48% of patients with bilateral (symmetric, vulgaris, or generalized) vitiligo had a positive test, indicating a lower rate of success. In addition, we reported that unilateral vitiligo was the best indication for surgical repigmentation.1.Falabella R. Arrunategui A. Barona M.I. Alzate A. The minigrafting test for vitiligo: Detection of stable lesions for melanocyte transplantation.J Am Acad Dermatol. 1995; 33: 1061-1062Abstract Full Text PDF PubMed Google Scholar This article is seldom cited, and the test was not done by many authors reporting treatment of extensive vitiligo areas with surgical methods for repigmentation; however, when performed in bilateral vitiligo, a more appropriate selection of patients allowed higher repigmentation rates.2.Boersma B.R. Westerhof W. Bos J.D. Repigmentation in vitiligo vulgaris by autologous minigrafting: Results in nineteen patients.J Am Acad Dermatol. 1995; 33: 990-995Abstract Full Text PDF PubMed Scopus (117) Google Scholar But surprisingly, we are glad to know that the figures of success that we anticipated in our work were correct, because they are very similar to what has been frequently reported thereafter. The paper on epidermal grafting, published by Gupta et al,3.Gupta S. Bhushan K. Epidermal grafting in vitiligo: Influence of age, site of lesion, and type of disease on outcome.J Am Acad Dermatol. 2003; 49: 99-104Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar is proof of our observation. The authors used this technique and followed 117 patients during at least 6 months, and found that in segmental/focal (unilateral) vitiligo 91% success was achieved, and only 53% successful repigmentation was observed in patients with generalized (bilateral) vitiligo. The authors also report that an analysis of the literature done in several studies where the same method was used showed 88% repigmentation for the unilateral type and 61% for bilateral vitiligo, figures that are quite similar to those in our study. Another article published by Mulekar4.Mulekar V. Melanocyte-keratinocyte cell transplantation for stable vitiligo.Int J Dermatol. 2003; 42: 132-136Crossref PubMed Scopus (80) Google Scholar with epidermal suspensions used as a method for repigmenting vitiligo disclosed that the percentage for excellent results in unilateral vitiligo was 84%, whereas repigmentation success for bilateral vitiligo was 53%. Again, these figures and the final conclusions in this paper, also claiming that unilateral vitiligo was the best indication for surgical repigmentation, are very similar to our reported findings. What we believe with these two articles and other publications by different authors, revealing similar percentages of repigmentation,5.Olsson M.J. Juhlin L. Long-term follow-up of leucoderma patients treated with transplants of autologous cultured melanocytes, ultrathin epidermal sheets and basal cell layer suspension.Br J Dermatol. 2002; 147: 893-904Crossref PubMed Scopus (134) Google Scholar, 6.Naeyaert J.M. Geel N. Ongenae K. Surgical treatment of vitiligo.Pigment Cell Res. 2003; 16: 590-591Crossref Google Scholar is that the findings of our minigrafting test have been validated, converting it into a powerful tool for detecting stable vitiligo, which anticipates the repigmentation success in vitiligo when surgery becomes a therapeutic option, as we proposed in our original paper. Furthermore, so far, the minigrafting test could be labeled as the most reliable tool to determine vitiligo stability, a finding that could also be useful to evaluate other parameters in vitiligo. These considerations lead us to a simple but important question: Should we perform extensive and unnecessary grafting in many patients with bilateral vitiligo—the clinical presentation where stability is more difficult to define—if we can anticipate with a simple tool, like the minigrafting test, a successful repigmentation by appropriately selecting patients that will respond much better to surgical interventions?