الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Segmental vitiligo is subtype of vitiligo characterized by a unilateral (semi)-dermatomal or Blaschkoid distribution, an onset in childhood or adolescence.
This pattern of vitiligo correlate best with mosaic skin disorders, suggesting that it may be influenced by somatic mutations in developing melanocytes.
The reported incidence of this type of vitiligo in the total group of vitiligo patients varies between 3.5 to 20.5%.
Vitiligo can be extremely disfiguring, leading to significant patient morbidity. Low self-esteem, poor body image and poor quality of life have been found in patients with vitiligo, especially in individuals of darker skin types.
It is generally thought that segmental vitiligo is a distinct subset of vitiligo, probably not immune mediated. It has been suggested that a dysfunction of the sympathetic nerves exists in the affected skin and plays a role in the pathogenesis of the disease. The association with auto-immune diseases, as seen in generalized vitiligo, seems to be absent or at least less significant. However, an auto- immune mechanism in segmental vitiligo cannot be ruled out. Indeed, systemic and topical steroids, psoralen and ultraviolet A (PUVA) and ultraviolet B (UVB) therapy can induce repigmentation or inhibit the further spreading of segmental vitiligo, supporting a possible role for the immune system in this disease.
The goal of vitiligo treatment is to control the damage to melanocytes and stimulate their migration from surrounding skin and adnexal reservoirs, i.e. to stop depigmentation and to stimulate repigmentation. For stopping depigmentation, besides UV therapies, systemic steroids seem to arrest disease progression. Commonly used repigmentation therapies for vitiligo include UV light (whole body irradiation or UV targeted to lesions), and topical agents (corticosteroids, calcineurin inhibitors, calcipotriol). Camouflaging or depigmenting (in disfiguring /widespread disease) are other current options.
The segmental vitiligo is more difficult to treat and requires early medical intervention or a surgical approach late in the disease course. With all types of vitiligo, timing of treatment is an important predictor of success, with early disease responding best In contrast to the segmental variant, most cases of vitiligo follow an unpredictable course, with periods of disease progression and quiescence.
Segmental vitiligo patients are best candidiate for surgical treatment, because of rapid stabilization and long period of stability after autologous grafting.
Several surgical options exist, which can be classified into tissue and cellular grafts.
Tissue grafts
As minigraft, split thickness skin graft and Suction blister epidermal grafting.
Cellular grafts
Cellular grafts can be cultured or noncultured melanocytes suspension from a thin to ultrathin skin graft.
The aim of this study was to compare autologous suction grafting with autologous epidermal sandpaper technique, both followed by narrow band ultraviolet B phototherapy (311 nm) in patients with stable segmental vitiligo, in terms of extent of repigmentation, patient satisfaction, complications, cost and ease of the procedure.
This study was performed on 30 patients with stable segmental vitiligo. Fifteen Patients underwent autologous suction grafting technique using 10ml sterile syringes as suction device. The other 15 patients underwent autologous epidermal sandpaper technique. In suction group, the syringes were applied firmly to the doner site, negative pressure were performed by pulling the plunger of sterile syringe till adequate pressure were achieved, then the needles used to fix the plunger of syringes.
Because of negative pressure the syringes will remains adhered to the skin, the syringes were left in place attached to the doner site for about 1.5-3 hours until a few small vesicles will appear in the suction area.
The small vesicles were increased significantly in size and were coalesced form a large blister. The skin of recipient site was dermabraded by using adermabrader device, the end point was reached when punctate bleeding points were observed, indicating that the upper papillary dermis had been reached.
The roof of the blister at the doner site were carefully cut with iris scissors at the periphery and the graft inverted on recipient sites and then spread fully over the dermabraded area with the help of forceps.
In sandpaper group(15 patients) was performed dermabrasion in the recipient area with a sterile sandpaper until minute bleeding points became visible. This sandpaper was discarded. Sandpaper of a normally pigmented and stable donor area was performed using the same technique. The obtained sandpaper material was applied directly over the dermaabraded achromic recipient area. Post-procedure, all patients in both groups were exposed to NB-UVB (311 nm), two sessions weekly for 3 months.
Skin biopsies were taken from the recipient area using 1.5mm punch instruments before and after treatment. Biopsies were stained for transmission electron microscopic study