Letter - Clinical
Successfully treatment of penile vitiligo patches and their sexual dysfunction consequences, by suction blister epidermal grafting
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In the treatment of refractory vitiligo such as vitiligo lesions in glabrous areas, medical treatment is disappointing. In recent years’ surgical interventions such as autologous non-cultured melanocyte grafting (ANCMG) and suction blister epidermal grafting (SBEG) were developed for the treatment of stable vitiligo.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> But vitiligo patches on problematic-to-treat areas, such as male genital even with this method may be with poor outcomes.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 32-year-old male was presented with depigmented patches located on the glans penis and associated SD from 58 and 32 months ago respectively. Laboratory examination, including thyroid, showed no abnormal findings. The patient was married 6 years ago, but 28 months later suffered from SD, because he and his wife feared that vitiligo was contagious. He had been subjected to multiple treatments including ANCMG by dermatology and Sexual Disorder Center (SDC) but had no appropriate treatment response. New lesions had not developed in the last 12 months.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We suggested SBEG because of problematic-to-treat areas and not responding to previous treatment. Firstly, anesthetized depigmented patches were abraded. The anterolateral of the leg consider a donor site and used funnel cylinder technique<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> is in order to harvest grafts. The harvested blister was detached; was then located over the recipient site.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We recommended partial bed rest for 7 days, being very careful when using the toilet, and avoidance of situations that induce penile erection. Complete repigmentation was achieved without any complication after 3 months (Figs. <a class="elsevierStyleCrossRef" href="#fig0005">1</a>–<a class="elsevierStyleCrossRef" href="#fig0015">3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">For the management of SD, we referred the patient to SDC. After 12 months, he presented with persistent repigmentation, improvement of SD and pregnancy of his wife.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Sukan and co-workers<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> demonstrated that chronic skin diseases such as vitiligo have undesirable influences on sexual activity. But other studies showed the presence or absence of genital vitiligo patches had not different effects on sexual functions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It seems in our patient, SD was consequence of vitiligo, because of was absent of no abnormality finding throughout evaluations at SDC and was induced SD prior to vitiligo.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In limited studies with a few cases of genital vitiligo, that were treated by ANCMG, poor to good repigmentation outcome was obtained.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">We believe that the failure of surgical interventions in male genital is related to its mobility, change in size, erection, susceptibility to infection and care, especially during the toilet.</p><p id="par0050" class="elsevierStylePara elsevierViewall">SBEG is an efficient method for the management of limited, stable, and resistant vitiligo with variable treatment results.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> In the SBEG method, fixation of recipient sites is very important in order to achieve an optimal outcome.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is very difficult to keep male genital in an immobility state.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the literature review, our patient is the first case, that successfully improved both vitiligo patches and SD through SBEG. We suggest SBEG in stable vitiligo patches on male genital with its SD consequence.</p><p id="par0060" class="elsevierStylePara elsevierViewall">This case report was approved by the Ethics Committee of Kermanshah University of Medical Sciences. The patient signed informed consent.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Mahmoudreza Moradi: Study conception and planning; critical literature review.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Hossein Kavoussi: Approval of the final version of the manuscript; effective participation in research orientation; study conception and planning; manuscript critical review.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Reza Kavoussi: Intellectual participation in propaedeutic and/or therapeutic management of studied cases; preparation and writing of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-04-14" "fechaAceptado" => "2021-05-20" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hajdaie Dermatology Clinic, Kermanshah, Iran.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1119 "Ancho" => 1675 "Tamanyo" => 397662 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0085" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Penile vitiligo.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1724 "Ancho" => 1675 "Tamanyo" => 442543 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0090" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Harvested epidermal graft located over the recipient abraded site.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1941 "Ancho" => 1675 "Tamanyo" => 679868 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0095" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Successful outcome of treated sites after 3 months.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of treatment response to autologous transplantation of noncultured melanocyte/keratinocyte cell suspension in patients with stable vitiligo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 33 | 6 | 39 |
| 2024 October | 213 | 71 | 284 |
| 2024 September | 315 | 110 | 425 |
| 2024 August | 281 | 124 | 405 |
| 2024 July | 214 | 110 | 324 |
| 2024 June | 171 | 73 | 244 |
| 2024 May | 134 | 73 | 207 |
| 2024 April | 190 | 86 | 276 |
| 2024 March | 141 | 67 | 208 |
| 2024 February | 142 | 94 | 236 |
| 2024 January | 130 | 57 | 187 |
| 2023 December | 144 | 69 | 213 |
| 2023 November | 141 | 116 | 257 |
| 2023 October | 125 | 91 | 216 |
| 2023 September | 103 | 92 | 195 |
| 2023 August | 138 | 49 | 187 |
| 2023 July | 149 | 67 | 216 |
| 2023 June | 187 | 82 | 269 |
| 2023 May | 140 | 51 | 191 |
| 2023 April | 155 | 34 | 189 |
| 2023 March | 159 | 55 | 214 |
| 2023 February | 85 | 51 | 136 |
| 2023 January | 37 | 44 | 81 |
| 2022 December | 38 | 20 | 58 |
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