Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Dermatology

Background: Acral vitiligo is known to show poor repigmentation, even after different forms of melanocyte grafting. Disturbances in the melanocyte environment affecting its motility have been reported in vitiligo particularly in those resistant areas. CO2 laser resurfacing has been found to induce some changes that can improve such abnormalities thus improving the motility of grafted melanocytes. It has shown superiority to dermabrasion when used for preparation of the recipient site. Objective: Evaluate the effect of applying repeated sessions of fractional CO2 resurfacing after non cultured epidermal cell suspension grafting to acral vitiligo skin prepared by total ablative CO2 resurfacing and to detect the changes in MMPs and E-Cadherins expression and the reflection of these changes on repigmentation. Method: A randomized prospective comparative study was carried on twenty patients with stable, acral vitiligo. Two acral symmetrical lesions were treated by non-cultured melanocyte keratinocyte cell suspension after preparing the recipient site by ablative CO2 laser. One randomly selected side received after healing of the graft site fractional CO2 laser resurfacing biweekly for six months. Biopsy was taken from the edge of both lesions before grafting and after repigmentation or 6 months and stained immunohistochemically for E-Cadherin and MMP2. Repigmentation appeared in fifteen cases (40%). Expression of E-Cadherin as well as both epidermal and dermal MMP2 significantly increased in all treated lesions. No significant differences were detected in the percent or onset of repigmentation or the immnunohistochemical changes between the side treated with post grafting fractional CO2 and the other side

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