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ORIGINAL ARTICLE
Year : 2016  |  Volume : 36  |  Issue : 1  |  Page : 4-10

The effect of ER:YAG plus 5-fluorouracil on the outcome of punch grafting in nonsegmental vitiligo: a left–right comparative study


1 Department of Dermatology, Minia University, Minia, Egypt
2 Department of Dermatology, Zagazig University, Zagazig, Egypt
3 Department of Pathology, Zagazig University, Zagazig, Egypt

Correspondence Address:
Tag S Anbara
Dermatology Department, Minia University Hospital, Minia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-6530.194154

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Introduction Histopathologically, in vitiligo lesions, functioning melanocytes are absent and the inflammatory infiltrate is usually minute and trivial. Among the surgical methods used is minigrafting, which is considered the safest and easiest by many practitioners. Best results were obtained in segmental type and in the lesions involving the face. Application of topical 5-fluorouracil (5FU) on ER : YAG-ablated skin had been previously used with success in treating vitiligo lesions even in difficult-to-treat areas such as the fingers. Aim of the study In this study, we tried to explore the effect of the prior application of 5FU on ER : YAG-ablated skin on the outcome of punch grafting in lesions that were unresponsive to phototherapy and were known to have moderate prognosis with surgery. Patients and methods The study was a prospective left–right comparative study that was carried out on 20 patients with nonsegmental vitiligo who were in need for surgery after the exclusion of facial and periungual lesions. Histopathological and immunohistochemical comparison between the two modalities were also made using the sequential biopsy technique. Results The clinical outcome was significantly better on the site pretreated with ER : YAG laser ablation and 5FU (P=0.001). Inflammatory cells in the form of dermal CD4+ and CD8+ cells were present in all operation sites showing depigmentation (32 lesions). Of them, 28 cases (87.5%) showed invasion of the lower layers of the epidermis in close proximity to the melanocytes by the CD8+ cells. Histopathological and immunohistochemical results were similar on both sides. Conclusion The prior application of 5FU on ER : YAG-ablated skin yields better clinical results that were not explained by the histopathological findings. We suggest that both mechanical and immunologic mechanisms were involved in the process of repigmentation on using this manoeuvre.


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