successful treatment of vitiligo with punch graft followed by outdoor topical Psoralen Plus Ultraviolet A radiation

Background and Objective – Punch grafting is a therapy for vitiligo but, to our knowledge, its combination with outdoor topical psoralen plus ultraviolet A radiation (PUVA) has not yet been studied. This study was designed to evaluate the efficacy of combination of punch graft and outdoor topical PUVA in recalcitrant vitiligo.Methods – The study was performed in Razi Hospital, Tehran in 2000. After obtaining informed consent, 20 patients with stable and refractory vitiligo (4 segmental, 8 focal and 8 generalized) underwent treatment with punch grafting. After 3 months, outdoor topical PUVA with 8-methoxypsoralen was instituted and continued for a maximum of 4 months.Results – After the 3 months of punch grafting, only nine patients experienced 33 – 66% repigmentation. Four months after starting topical outdoor PUVA, 13 patients experienced 90 – 100% and three patients 25 – 50% repigmentation. One focal and three generalized patients showed no response.Conclusion – The combination of punch grafting and topical PUVA may be an effective treatment in stable and intractable vitiligo, especially the segmental and localized types.