%0 Journal Article
%T Possible Mechanisms by Which Topical 5-Fluorouracil and Dermabrasion Could Induce Pigment Spread in Vitiligo Skin: An Experimental Study
%A Y. Gauthier
%A T. Anbar
%A S. Lepreux
%A M. Cario-Andr¨¦
%A L. Benzekri
%J ISRN Dermatology
%D 2013
%R 10.1155/2013/852497
%X The combination of skin ablation and 5-Fluorouracil (5-FU) ointment was previously tried in the treatment of vitiligo, and good results were specifically reported in glabrous skin without follicular melanocyte reservoirs. Methods. This study was carried out on the skins of seven guinea pigs: three were treated with mechanical dermabrasion plus topical 5-FU in an achromic area contiguous to a pigmented area; two were treated by only dermabrasion in a similar area; and two were treated by topical 5-FU alone. Clinical, histological, and ultrastructural studies were performed over two months. Results. In guinea pigs treated with dermabrasion plus 5-FU, we observed firstly a delay of wound healing with an obvious inflammatory reaction, and, after two months, evident pigment spread from the pigmented into the achromic area. After six months, we noticed black hair regrowing in the achromic area. Pigment spread was not seen in the guinea pigs skin treated by either dermabrasion or topical 5-FU. We suggest that the inflammatory mediators and enzymes (metalloproteinases), which are locally released over a long time, could stimulate and facilitate melanocyte proliferation and migration through the enlarged intercellular spaces of the epidermis. This sequence of events may be applied to vitiligo patients treated with 5-FU on ablated lesions. 1. Introduction Vitiligo affects 1% of the world¡¯s population and probably has a higher incidence in dark-skinned individuals. Three repigmentation patterns are usually described: perifollicular, when the predominant repigmentation is follicular; marginal, when the predominant repigmentation is from the borders of patches; and diffuse, when repigmentation occurs across the patches of vitiligo [1]. Nb-UVB phototherapy is considered to be a very important modality in vitiligo treatment. Its efficacy is mainly due to the stimulation of the perifollicular repigmentation and rarely to the repigmentation from the edges, so treatment of glabrous areas localized on the elbows, the dorsa of the hands, fingers, wrists, and feet is presently challenging. Application of 5-Fluorouracil (5-FU) after mechanical dermabrasion, as a treatment for vitiligo, was introduced by Tsuji and Hamada in 1983 [2], and its efficacy was successively confirmed by other authors [3¨C5]. Successful repigmentation of areas devoid of hair follicles (periungueal areas and the dorsa of the feet) was first reported by Anbar after ER: YAG laser skin ablation followed by topical application of 5-FU and Nb-UVB phototherapy [6¨C8]. At first sight, this effective
%U http://www.hindawi.com/journals/isrn.dermatology/2013/852497/