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| ORIGINAL ARTICLE |
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| Year : 2018 | Volume
: 22
| Issue : 2 | Page : 72-74 |
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Follicular unit extraction technique in treating stable vitiligo with leukotrichia
Arragudla Vikram Kumar, Anchala Parthasaradhi
Anchala Skin Institute, Hyderabad, Telangana, India
| Date of Web Publication | 21-Sep-2018 |
Correspondence Address:
Dr. Arragudla Vikram Kumar
Plot 1168, Road No 58, Ayyappa Society, Madhapur, Hyderabad - 500 081, Telangana
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jdds.jdds_25_18
Background: There are several surgical modalities to repigment vitiligo patches, and follicular unit extraction (FUE) is one among them. This procedure is based on the concept of the presence of undifferentiated stem cells in the hair follicle which are a very good source of melanocytes. These melanocytes spread to the surrounding skin and repigment the epidermis. Materials and Methods: Three cases with few lesions of stable vitiligo over nonglabrous areas were treated with follicular unit grafts using the FUE method. Repigmentation in the vitiligo patches was assessed by subjective analysis. Results: Repigmentation was noticeable in all cases with an average duration of 3 weeks. Almost complete repigmentation was seen in all cases with an average duration of 7.3 weeks. Conclusion: FUE appears to be an effective method in treating vitiligo patches with leukotrichia.
Keywords: Follicular unit extraction, hair transplant, leukotrichia, vitiligo
How to cite this article:
Kumar AV, Parthasaradhi A. Follicular unit extraction technique in treating stable vitiligo with leukotrichia. J Dermatol Dermatol Surg 2018;22:72-4 |
| Introduction | |  |
Vitiligo is an age-old disease which affects 2%–5% of population in India with increasing prevalence every year. It not only affects the skin but also affects social, emotional health of an individual. The aim of this report is to describe the outcome of the follicular unit extraction technique (FUE) in cases of stable vitiligo with leukotrichia.
| Materials and Methods | | |
This study involves localized and stable vitiligo patches in nonglabrous areas of the body. This study was done at Anchala Skin Institute, Hyderabad, from March 2017 to October 2017. Patients with stable and localized vitiligo with leukotrichia were selected. The patients with a history of active vitiligo, Koebner phenomenon, keloid tendency, and bleeding disorders were excluded from the study.
Procedure
Written informed consent was taken from all the patients. A complete history of vitiligo onset, duration, progression, site, and type of vitiligo was obtained from patients before the start of the procedure. All relevant blood tests, including complete blood counts, bleeding time, and clotting time, were normal. The viral screening was negative.
Lignocaine and bupivacaine sensitivity was done before the procedure. Photographs were taken before, at the time of the procedure, after the procedure, and periodically thereafter to assess repigmentation.
Tumescent anesthesia was given in the donor area, and grafts were extracted using a 0.8-mm punch in Case 1 and Case 2 and a 0.7-mm punch in Case 3. The donor area was occipital region in Case 1 and Case 2 and just above the nape of the neck in Case 3. Extracted grafts were stored in chilled saline until the completion of the procedure. Grafts were implanted using a 19G needle and jeweler's forceps in the recipient site after tumescent anesthesia was given. The grafts were implanted with a separation between the grafts of about 5 mm. Phototherapy was initiated from the 10th day of procedure. All the patients were followed for every 2 weeks for 6 months.
| Case Reports | | |
Case 1
A 25-year-old male patient presented with depigmented patches on the chest [Figure 1] and back [Figure 2] for 10 years. The lesions were nonprogressive and stable for the last 5 years. He took topical medications and phototherapy but with no improvement. FUE technique was performed over the depigmented patches. | Figure 1: Case 1 – Chest area – depigmented patch with leukotrichia (a) before procedure, (b) implanted grafts on the day of procedure, and (c) perifollicular pigmentation after 6 weeks
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 | Figure 2: Case 1 – Upper back area – depigmented patch with leukotrichia (a) before procedure, (b) implanted grafts on the day of procedure, and (c) perifollicular pigmentation after 6 weeks
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Case 2
A 27-year-old male patient presented with single depigmented patch over the right leg for 3 years. He has been using several topical medications but with no relief. The lesions are stable for the last 2 years. FUE was performed over a small area of the vitiligo patch [Figure 3]. Repigmentation was observed [Figure 4]. | Figure 3: Case 2 – Right leg with a depigmented patch with leukotrichia and rectangle box represents area selected for implantation of grafts
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 | Figure 4: Case 2 – (a) Implanted grafts on the day of the procedure, (b) 10 days after the procedure, (c) after 8 weeks, and (d) after 14 weeks
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Case 3
A 24 year old male patient presented with depigmented patch over the right eyebrow region along with leukotrichia of eyebrows. He had been applying topical medication and phototherapy with no improvement. FUE technique was performed after the removal of few eyebrow hairs [Figure 5]. Repigmentation was observed after the procedure [Figure 6]. | Figure 5: Case 3 – (a) Before procedure – depigmented patch with leukotrichia and (b) close-up view
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 | Figure 6: Case 3 – (a) Implanted grafts on the day of procedure, (b) after 4 weeks, and (c) after 8 weeks
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| Discussion | | |
Repigmentation was noticeable surrounding the grafted hair follicles after an average of 3 weeks. Almost complete repigmentation was seen an average of 7 weeks. Repigmentation in vitiligo starts around the hair follicles due to the reservoir of melanocytes in the follicle.[1] There are two types of cells, the active and inactive melanocytes in hair follicle, which form a good source of melanocytes. In vitiligo, the active melanocytes are destroyed whereas the inactive ones are preserved, and these inactive melanocytes form the major source of repigmentation. Once activated, these melanocytes can migrate to and repigment the surrounding epidermis.[2]
Phototherapy stimulates melanocytes and their migration from the hair follicle.[3] After FUE, the spread of pigmentation around the follicles ranged from 5 to 12 mm.[4] Hair grafting in vitiligo can be an excellent modality, especially in those with leukotrichia, which are difficult to treat with other methods. Advantages of FUE[5],[6] include hair grafting is less invasive, little visible scar in donor area that gets covered by surrounding hair, less chance of hypertrophic scar in recipient area as small bore needle is used, hair follicle melanocytes are relatively more resistant to vitiligo as compared to epidermal melanocytes, the technique can be easily applied to small area, it can be performed in difficult sites such as eyelashes, angle of mouth where other surgical treatments are difficult to perform, the hair follicle contains more melanocytes than normal epidermis, and the cause of a more acceptable color match in hair transplantation than in other methods could be related to the stem cell migration from the graft and then location-specific transient that amplifies cells proliferation.[7]
| Conclusion | | |
FUE can be an effective method for repigmenting refractory vitiligo cases like those with leukotrichia. Leukotrichia also improved with this procedure, although it may take more time compared to the skin pigmentation changes.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Cui J, Shen LY, Wang GC. Role of hair follicles in the repigmentation of vitiligo. J Invest Dermatol 1991;97:410-6.  |
| 2. | Staricco RG. Amelanotic melanocytes in the outer sheath of the human hair follicle. J Invest Dermatol 1959;33:295-7. |
| 3. | Ortonne JP, Schmitt D, Thivolet J. PUVA-induced repigmentation of vitiligo: Scanning electron microscopy of hair follicles. J Invest Dermatol 1980;74:40-2. |
| 4. | Malakar S, Na GY, Lahiri K. Transplantation of hair follicles for vitiligo. In: Gupta S, Olsson MJ, Kanwar AJ, Ortonne JP, editors. Surgical Management of Vitiligo. 1 st ed. New Delhi: Wiley-Blackwell; 2007. |
| 5. | Na GY, Seo SK, Choi SK. Single hair grafting for the treatment of vitiligo. J Am Acad Dermatol 1998;38:580-4. |
| 6. | Kumaresan M. Single-hair follicular unit transplant for stable vitiligo. J Cutan Aesthet Surg 2011;4:41-3. [ PUBMED] [Full text] |
| 7. | Thakur P, Sacchidanand S, Nataraj HV, Savitha AS. A study of hair follicular transplantation as a treatment option for vitiligo. J Cutan Aesthet Surg 2015;8:211-7. [ PUBMED] [Full text] |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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