Autologous Skin Graft-Erbium:YAG Laser Treatment Helpful in Piebaldism

Laurie Barclay, MD

April 27, 2004

April 27, 2004 — Erbium:YAG laser treatment followed by autologous cultured epidermal grafting induced permanent repigmentation of piebald lesions, according to the results of a study published in the April issue of the British Journal of Dermatology. The investigators describe this surgical procedure as rapid, simple, and noninvasive.

"Several surgical techniques have been proposed for the treatment of piebaldism. These procedures, however, are poorly suited for the treatment of large leucodermal lesions, can cause scars and require multiple donor sites," write L. Guerra, from the Istituto Dermopatico dell'Immacolata in Rome, Italy, and colleagues. "Recently, it has been reported that autologous cultured epidermis induces scarless repigmentation of large vitiligo lesions, using a single small donor site."

In this study, six patients with piebaldism had removal of achromic epidermis via appropriately set erbium:YAG laser followed by application of autologous cultured epidermal grafts on the recipient bed. The 3,4-dihydroxyphenylalanine reaction was used to determine melanocyte content, and a semiautomatic image analysis system calculated the percentage of repigmentation.

Autologous cultured epidermis containing a controlled number of melanocytes induced repigmentation of all piebald lesions, with mean percentage repigmentation of 95.45% (2,791.5 cm 2 repigmented/2,924.2 cm 2 transplanted).

"Autologous cultured epidermal grafts induce permanent and complete repigmentation of piebald lesions, in the absence of scars," the authors write. "Erbium:YAG laser surgery is a rapid and precise tool for disepithelialization, hence allowing treatment of large piebald lesions during a single surgical operation."

The main disadvantages of this technique include the need for safe and controlled cell culture facilities, the level of expertise and the number of quality controls required, and a mean cost of approximately $1,200 for each 1% body surface covered.

Br J Dermatol. 2004;150:715-721

Reviewed by Gary D. Vogin, MD