Sureka, D (2017) A Comparative study on the Degree of Repigmentation of Punch Grafting and Topical 5-Fluorouracil on Dermabraded Skin in the Treatment of Vitiligo. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND: Vitiligo is a pigmentary disorder which causes adverse psychological impact on the quality of patient’s life due to its cosmetic unacceptability. Though multiple treatment options are available, results greatly vary among them. AIM OF THE STUDY: My aim is to compare the degree of repigmentation and cosmetic outcomes of two surgical modalities namely punch grafting and topical 5-flurouracil on dermabraded skin. MATERIALS AND METHODS: PLACE OF STUDY: Department of Dermatology, RGGGH, Chennai. TIME PERIOD OF STUDY: One year. SAMPLE Size: 40 cases. TYPE OF STUDY: Prospective, Interventional & Comparative study. 40 patients with focal vitiligo attending dermatology op at RGGGH were randomized into two groups of 20 each. All necessary investigations were done and consent obtained for surgical procedures. In the Group A punch grafting was done followed by PUVASOL for 6 months. In Group B topical 5 fluorouracil was applied after dermabrasion for 3 sittings every 2 weeks. Patients were reviewed fortnightly for the first 2 months and then monthly for the next 4 months. Cosmetic results of the procedures were finally analysed after 6 months by independent dermatologists in our department. Results were analysed based on the percentage of repigmentation in the treated lesion and also by patient response. Based on repigmentation results are classified as : Excellent when more than 75% of the lesion is repigmented. Good to moderate when 25 to 75% repigmentation attained. Poor when less than 25% of the lesion is repigmented. Patient response is obtained by asking them to mark their response in the visual analogue scale and then response is grouped as : Excellent : 9 and 10 Good : 6-8Average : 3-5 Poor : 0-2. Pre and post procedure DLQI score is calculated. RESULTS: Of the 40 patients participated in the study, 92.5% showed varying degrees of repigmentation. Successful pigmentation of more than 75% was seen in 15% in group A and 30% in group B. 25 to 75% repigmentation was seen in 65% in group A and 50% in group B. Less than 25% repigmentation was observed in 15% in group A and 10% in group B. 3(7.5%) patients showed no repigmentation. As per patient response, the cosmetic acceptability was excellent in 50% of patients in group B whereas only 10% in group A showed excellent response. The response was good in 50% of group A and 30% of group B patients. It was average in 20% and poor in 10% of total patients studied. The mean DLQI in group A before the procedure was 10.15. Post procedure mean DLQI was 7.30. The preprocedure mean DLQI in group B was10.75 which reduced to 7.15 post procedure. Discussion: In the punch grafting group, repigmentation started at around 1 month after the procedure in almost all the cases and perigraft pigmentation of 5 to 10 mm was achieved. In 5 FU group repigmentation started by third week in some patients and few others by 2 months. This was little earlier than with punch grafting. In 10% of group A patients the perigraft pigmentation is darker than normal skin. Cobble stone effect noted in 3 patients in group A. The patients in group B showed maximal reduction in DLQI. CONCLUSION: Vitiligo treatment has no single validated outcome measure. In our study patient’s response on treatment outcome is included along with percentage of repigmentation. Dermabrasion combined with topical 5 Fluorouracil is the most cosmetically acceptable treatment in our study. The repigmentation rates are almost similar in punch grafting and dermabrasion combined with topical 5 Fluorouracil. The onset of pigmentation is rapid in the 5 FU group. DLQI is also an additive tool in assessing subjective improvement in the disease condition after treatment. The side effects observed with 5 FU are minor and resolved with conservative management. Even though punch grafting is equally good in pigmentation rates, it scored less in patient’s response because of the cobble stoning and hyperpigmentation.
| Item Type: | Thesis (Masters) |
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| Additional Information: | Reg.No.201330008 |
| Uncontrolled Keywords: | Vitiligo, Punch grafting, 5-Fluorouracil, Dermabrasion. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Jul 2020 16:58 |
| Last Modified: | 22 Jul 2020 16:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12644 |
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