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Journal Of the American Academy of Dermatology
Treatment outcomes and prognostic factors of motorized 0.5-mm micropunch grafting with a skin-seeding technique for 83 cases of vitiligo in children
Jin Cheol Kim, MD,a Dong Chan Kim, MD,a Hee Young Kang, MD, PhD,a and Dong Seok Kim, MD, PhDb
To the Editor: Childhood vitiligo is mostly of the segmental type, showing more stable progression and better responses to surgical treatments.1 However, the painful and time-consuming procedure of conventional skin grafting presents a major challenge for refractory childhood vitiligo. Recently, motorized micropunch grafting with skin-seeding technique (SST) was introduced,2,3 promising better compliance for children due to its easier and faster procedure with less pain. In this study, we evaluated the treatment outcomes and prognostic factors of the modality in childhood vitiligo.

A total of 83 vitiligo subjects less than 20 years old who underwent SST between January 2010 and December 2017 were retrospectively enrolled. Grafting was performed for stable (no disease progression for $6 months) and refractory (no improvement with nonsurgical treatments) vitiligo. The donor and recipient sites were harvested using a motorized 0.5-mm micropunch (i-graft; Ilooda) and were grafted irrespective of the epidermal-dermal orientation.2,3 One week after surgery, all surgical sites were treated with an excimer laser with 0.1% tacrolimus ointment. Two dermatologists evaluated the repigmentation rate by comparing clinical photographs at baseline with those on follow-up visits. The disease stability time was defined as the period with no previous lesions progressing and no new lesion developing.

All enrolled subjects had $3 months of follow-up time (mean, 11.1 months) after surgery. A total of 76.0% showed good treatment response ([75% of repigmentation) (Supplementary Table I and Fig 1, available via Mendeley at 3ddj39vc9d.2). Partial (50%-75%) and poor (\50%) treatment responses accounted for 12% each. The subjects were divided into success ( good response) and nonsuccess groups for logistic regression analysis. Face and neck lesions (only in univariate analysis; odds ratio ¼ 0.241; P ¼ .043) and longer disease stability time exceeding 12 months (adjusted odds ratio ¼ 9.889; P ¼ .017) are associated with good prognosis for treatment success (Table I). An acceptable mild pain (Numeric Pain Intensity Scale score, #2) during local anesthesia was observed. Cobblestoning (n ¼ 3), color mismatch (n ¼ 1), and hyperpigmentation (n ¼ 2) were reported in the extremities, which had improved over time. No other adverse events were noted, and all the patients had been satisfied thorough the procedure regardless of treatment outcomes.

SST in childhood vitiligo showed a comparable success rate with less cobblestoning compared with previous micropunch grafting studies involving allage groups.2-4 Younger patients usually showed a higher success rate of micropunch grafting than older patients2,4 due to a higher portion of segmental vitiligo and a higher melanocyte viability rate.1 The face and neck lesions were associated with good treatment response, a finding consistent with those in previous studies.2,4 A disease stability time exceeding 12 months was another important good prognostic factor. Because disease stability is known as the most important prognostic factor before a vitiligo surgery,5 a clinical evaluation of the stability status of vitiligo should be conducted before surgery. This investigation was limited given the different follow-up times due to retrospective study.

In summary, this study showed that motorized micropunch grafting with SST is an effective promising surgical treatment for childhood vitiligo especially on the face and neck with disease stability of > 12 months.

Jin Cheol Kim, MD,a Dong Chan Kim, MD,a Hee Young Kang, MD, PhD,a and Dong Seok Kim, MD, PhDb
From the a Department of Dermatology, Ajou University School of Medicine, Suwon-si, South Korea; and Eureka Skin & Laser Clinic, Seoul, South Korea.b
Authors Hee Young Kang and Dong Seok Kim are co-corresponding authors.
Funding sources: None.
IRB approval status: This study design was reviewed and approved by the Institutional Review Board of Ajou University Hospital (AJIRB-MEDMDB-21-519).
Key words: children; grafting; punch grafting; surgery; vitiligo.
Reprints not available from the authors.
Correspondence to: Dong Seok Kim, MD, PhD, Eureka Skin & Laser Clinic, 101, Teheran-ro, Gangnam-gu, 06134, Seoul, South Korea
Hee Young Kang, MD, PhD, Department of Dermatology, Ajou University School of Medicine,Suwon-si, South Korea
Conflicts of interest
None disclosed

REFERENCES 1. Nicolaidou E, Antoniou C, Miniati A, et al. Childhood- and later-onset vitiligo have diverse epidemiologic and clinical characteristics. J Am Acad Dermatol. 2012;66(6):954-958.
2. Bae JM, Lee JH, Kwon HS, Kim J, Kim DS. Motorized 0.8-mm micropunch grafting for refractory vitiligo: a retrospective study of 230 cases. J Am Acad Dermatol. 2018;79(4):720-727.e1.
3. Kim DS, Ju HJ, Lee HN, et al. Skin seeding technique with 0.5-mm micropunch grafting for vitiligo irrespective of the epidermal-dermal orientation: animal and clinical studies. J Dermatol. 2020;47(7):749-754.
4. Kato H, Furuhashi T, Ito E, et al. Efficacy of 1-mm minigrafts in treating vitiligo depends on patient age, disease site and vitiligo subtype. J Dermatol. 2011;38(12):1140-1145.
5. Lahiri K, Malakar S. The concept of stability of vitiligo: a reappraisal. Indian J Dermatol. 2012;57(2):83-89.