Punch Grafting in Vitiligo: Different Factors which Affect the Results

Background. In stable vitiligo several techniques of autologous melanocyte transplantation are used. Punch grafting is the easiest and least expensive. Objective. To assess the effect of patient and treatment variables on results of punch grafting. Patients and methods. Thirty-two vitiligo lesions in twenty patients were treated by punch grafting. After grafting, 13 patients received PUVA and 7 patients received topical psoralen sun (PUVASOL) for 3 months. Response was assessed according to extent of pigmentation (Excellent 90%, very good 75 - 90%, good 50 - 75% and poor response . 50%). Mean margin of pigment spread (MPS) in mm was calculated for each patient. The effect of different factors on the response and development of side-effects was assessed in lesions achieving 50% pigmentation (good - excellent response). Results. Nine lesions (28%) showed excellent, 15 (47%) very good, 5 (16%) good and 3 (9%) a poor response. The mean MPS was 3.7 ± 0.78 mm. Age had a significant positive correlation with MPS (r = 0.488, p = 0.007) while skin type and region treated had none. Punch sizes and the difference between donor and recipient punches did not affect MPS statistically. Donor punch size (r = - 0.808, p = 0.000) and recipient punch size(r = - 0.801, p = 0.000) had a significant negative correlation with the number of grafts remaining in place. No significant difference in MPS was found between patients on PUVA vs PUVASOL therapy after grafting (p = 0.068). Cobble-stoning occurred in 5 lesions (16%). The smaller the donor (p = 0.002) and recipient (p = 0.003) punch sizes the less was the cobble-stoning.Conclusion. Punch grafting is an effective, easy and inexpensive treatment of localized stable vitiligo. Of the different studied variables, age had a significant positive correlation with MPS. Using smaller punch sizes improved the response and reduced cobble-stoning. No significant difference in MPS was found between patients receiving PUVA therapy vs topical PUVASOL after grafting, making this technique applicable for patients with no access to phototherapy centers.