Heal House Vitiligo Research 19 · Original Article
Vitiligo That Does Not Respond to Excimer Laser, What Is the Effectiveness of Micropunch Grafting?
Motorized 0.8-mm micropunch grafting for refractory vitiligo: A retrospective study of 230 cases
Last reviewed
In short
In refractory vitiligo that did not improve with excimer laser or phototherapy, motorized 0.8 mm micro-punch grafting restored color in about eight out of ten cases. It is a fast and simple surgical alternative.
There is a type of vitiligo where color rarely returns no matter how long you apply topical treatments or receive light therapy. For these lesions, transplanting melanocytes from healthy skin can be a solution. However, the traditional method took a long time. It also had the drawback of the transplanted site becoming bumpy, like pebbles. To reduce these disadvantages, I devised a grafting technique using a very thin 0.8 mm motorized punch. I then carefully reviewed the results in actual patients.
Q1 What can be done for vitiligo that does not improve with excimer laser or light therapy?
Transplanting melanocytes from healthy skin can be a solution. If vitiligo is stable and not spreading, yet color does not return with excimer laser or light therapy, it means there are few viable melanocytes left in that area. In this case, transferring melanocytes from normal skin can allow new color to return. However, the traditional punch grafting method took a long time and had the disadvantage of the transplanted site becoming bumpy like pebbles. To improve this, I devised a method using a very thin 0.8 mm motorized punch.
Q2 What was the success rate of this procedure?
Color successfully returned in about eight out of ten cases. We examined 230 lesions from 208 patients with refractory vitiligo. Among them, 78.7% achieved 75% or more repigmentation within about 6 months, with the use of excimer laser after the surgery. Results were particularly good for lesions on the face and neck, and for lesions that had been stable without spreading for 12 months or more. The table below summarizes the success rate and the frequency of major side effects. For stable lesions, these results are quite promising.
Results of Motorized 0.8 mm Micropunch Grafting (230 lesions)
| Item | Value | In simple terms |
|---|---|---|
| Treatment success (75% or more repigmentation) | 78.7% | Success in about 8 out of 10 cases |
| Color appearing different from surrounding skin | 24.8% | About 1 in 4 patients |
| Pebble-like surface | 18.3% | About 1 in 5 to 6 patients |
Q3 Were there any side effects or drawbacks?
There were no serious side effects, and they were generally well tolerated. The most common was the color of the transplanted site appearing slightly different from the surrounding skin, which occurred in about 1 in 4 patients. A pebble-like unevenness of the surface occurred in about 1 in 5 to 6 patients. However, because we used a thin 0.8 mm punch, the bumpiness was reduced compared to the traditional method, and the procedure time was significantly shortened. It can be performed in a relatively short time in an outpatient setting, making it less burdensome for those who have difficulty sitting for long periods. Of course, this surgery is suitable for patients whose disease is stable. The timing and patient selection should be carefully determined through a consultation.
Closing remarks
Thanks to this method, we are now able to offer a new option to patients with refractory vitiligo who were weary from hearing, "There is nothing more we can try." The short procedure time, respectable success rate, and tolerable side effects make this surgery a realistic alternative even in a busy outpatient practice. For those who have suffered emotionally because their color did not return for a long time, this provides one more reason not to give up.
