Long-term Follow-up Study Of Vitiligo Patients Treated With Autologous Suction Blister Epidermal Grafting

BackgroundVitiligo is a common depigmentary disease with a great impact on patients' quality of life, both physically and psychologically. Surgical treatment gives a high rate of successful repigmentation that appears to be durable in patients with stable vitiligo. However, the transplantation of melanocytes can't treat the potential etiological factor, and the relapse may induce the failure of transplantation and Koebner phenomenon. Thus, there are no long-term follow-up studies about the efficacy of epidermal grafting till now. Long-term follow-up studies are usually faced with poor compliance and high quit rate. Phone interview is applied in epidemiological assessments, health education of chronic diseases and morbidity of common diseases, which can attain equivalent results as face-to-face interview.ObjectiveUsing the phone interview to evaluate the long-term outcome of autologous suction blister epidermal grafting in vitiligo and its correlated factors.MethodsThe long-term follow-up of patients treated by epidermal grafting 5 to 9 years ago was carried out by phone interview. The relevance was estimated between the repigmentation rate, color matching and migration of repigmentation, subjective evaluation and related factors, including patients' age, gender and course of disease, types of vitiligo, location of lesions treated, activity of disease, Koebner phenomenon on the donor sites and so on. We want to follow up the long-term outcome and the rate of depigmentation after epidermal graft.ResultsOf the 225 patients with 2421 grafting epidermal sheets,107 were males and 118 females with an average age of (27.55±12.56) years and average course of (5.84±5.87) years. Fifty-two patients suffered with segmental vitiligo,97 with localized vitiligo, 63 with disseminated vitiligo,1 with generalized vitiligo,12 with distal vitiligo. They achieved average repigmentation rate of (89.50±25.25)%, subjective evaluation points of (3.45±1.34) and color matching points of (3.30±1.30), incidence rate of migration of repigmentation was 26.77%. Koebner phenomenon in the donor sites was noticed in only one patient, but the hyperpigmentation was occurred in 12.89% of all patients. Relapse developed in 14.22% of all patients, and hypopigmentation developed in the recipient area of 9.48% of patients.There was no statistical difference of area and color matching of repigmentation between different follow-up years. Males had higher subjective evaluation points than females.The elder patients had bigger area of repigmentation. Better efficacy was observed in those who had longer course of disease. Segmental vitiligo had best results while distal vitiligo had poor effect. The location of lesions didn't correlate to the area of repigmentation, but face and neck got the best color matching of repigmentation while the extremity earned the poorest. The hyperpigmentation on the donor sites leaded to lower color matching points on the recipient sites. The relapse of vitiligo happened more frequent in those patients with hypopigmentation. Combined epidermal grafting with other therapy leaded to hypopigmentation, failure transplantation and less migration of repigmentation.ConclusionsLong-term follow-up showed that autologous suction blister epidermal grafting had a stable efficacy. Males had higher subjective evaluation points. The elder patients had bigger area of repigmentation. Better efficacy was observed in those who had longer course of disease. Segmental vitiligo had best results while distal vitiligo had poor effect. The location of lesions treated didn't correlate to the area of repigmentation. The hyperpigmentation on the donor sites leaded to lower color matching points on the recipient sites. The hypopigmentation of recipient sites closely correlated with the relapse of vitiligo. Combined epidermal grafting with other therapy should be further followed up.