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Original Investigation
February 17, 2021

Surgical Interventions for Patients With Vitiligo: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Dermatology, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul
  • 2Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigharh, India
  • 3Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
  • 4Vitiligo Unit, Multicultural Dermatology Center, Henry Ford Hospital, Detroit, Michigan
  • 5Epidemiology in Dermatology and Evaluation of Therapeutics, Département Infectieux/Immuno/Vaccin, Paris-Est University, Paris Est Créteil University, Créteil, France
  • 6Department of Dermatology, Mondor Hospital, Assistance Publique–Hôpitaux de Paris, Paris Est Créteil University, Créteil, France
JAMA Dermatol. Published online February 17, 2021. doi:10.1001/jamadermatol.2020.5756
Key Points

Question  What are the treatment outcomes and adverse effects of surgical interventions for patients with vitiligo?

Findings  In this systematic review and meta-analysis that included 117 unique studies and 8776 unique patients, the rates of repigmentation above 90% and above 50% after a single session of all surgical interventions were 52.69% and 81.01%, respectively.

Meaning  These findings suggest that surgical intervention can be an effective and safe option for managing refractory stable vitiligo; selection of appropriate patients in terms of disease stability and suitable surgical procedure is important.

Abstract

Importance  Surgical interventions are a key part of the therapeutic arsenal, especially in refractory and stable vitiligo. Comparison of treatment outcomes between the different surgical procedures and their respective adverse effects has not been adequately studied.

Objective  To investigate the reported treatment response following different surgical modalities in patients with vitiligo.

Data Sources  A comprehensive search of the MEDLINE, Embase, Web of Science, and Cochrane Library databases from the date of database inception to April 18, 2020, was conducted. The key search terms used were vitiligo, surgery, autologous, transplantation, punch, suction blister, and graft.

Study Selection  Of 1365 studies initially identified, the full texts of 358 articles were assessed for eligibility. A total of 117 studies were identified in which punch grafting (n = 19), thin skin grafting (n = 10), suction blister grafting (n = 29), noncultured epidermal cell suspension (n = 45), follicular cell suspension (n = 9), and cultured epidermal cell suspension (n = 17) were used.

Data Extraction and Synthesis  Three reviewers independently extracted data on study design, patients, intervention characteristics, and outcomes. Random effects meta-analyses using generic inverse-variance weighting were performed.

Main Outcomes and Measures  The primary outcomes were the rates of greater than 90%, 75%, and 50% repigmentation response. These rates were calculated by dividing the number of participants in an individual study who showed the corresponding repigmentation by the total number of participants who completed the study. The secondary outcomes were the factors associated with treatment response to the surgical intervention.

Results  Among the 117 unique studies and 8776 unique patients included in the analysis, rate of repigmentation of greater than 90% for surgical interventions was 52.69% (95% CI, 46.87%-58.50%) and 45.76% (95% CI, 30.67%-60.85%) for punch grafting, 72.08% (95% CI, 54.26%-89.89%) for thin skin grafting, 61.68% (95% CI, 47.44%-75.92%) for suction blister grafting, 47.51% (95% CI, 37.00%-58.03%) for noncultured epidermal cell suspension, 36.24% (95% CI, 18.92%-53.57%) for noncultured follicular cell suspension, and 56.82% (95% CI, 48.93%-64.71%) for cultured epidermal cell suspension. The rate of repigmentation of greater than 50% after any surgical intervention was 81.01% (95% CI, 78.18%-83.84%). In meta-regression analyses, the treatment response was associated with patient age (estimated slope, −1.1418), subtype of vitiligo (estimated slope, 0.3047), and anatomical sites (estimated slope, −0.4050).

Conclusions and Relevance  The findings of this systematic review and meta-analysis suggest that surgical intervention can be an effective option for refractory stable vitiligo. An appropriate procedure should be recommended based on patient age, site and size of the lesion, and costs.

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