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Liliana Guerra, MD; Grazia Primavera, MD; Desanka Raskovic, MD; Graziella Pellegrini, PhD; Osvaldo Golisano, PhD; Sergio Bondanza, BSc; Patrizia Paterna, BSc; Giulio Sonego, MD; Tommaso Gobello, MD; Francesco Atzori, MD; Paolo Piazza, MD; Antonio Luci, MD; Michele De Luca, MD

Arch Dermatol. 2003;139:1303-1310.

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 cm² repigmented/2315.8 cm² 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 cm² repigmented/1953.4 cm² 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.

From the Laboratory of Tissue Engineering (Drs Guerra, Pellegrini, Golisano, and De Luca and Mr Bondanza and Ms Paterna), V° Division of Dermatology (Dr Primavera), VI° Division of Dermatology (Drs Raskovic and Atzori), Day Surgery (Dr Sonego), VIII° Division of Dermatology (Dr Gobello), Aesthetic Dermocosmetology (Dr Piazza), and Dermatological Surgery (Dr Luci), Istituto Dermopatico dell'Immacolata, Rome; and Fondazione Banca degli Occhi del Veneto, Venice (Drs Pellegrini and De Luca), Italy. The authors have no relevant financial interest in this article.

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