الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Vitiligo is a common pigmentary disorder, of great sociomedical importance, affecting nearly 1–2% of the population. It is defined clinically as sharply demarcated, acquired, idiopathic, progressive, depigmentation of skin and hair, and is characterized by total absence of melanocytes microscopically.
It remains unclear what causes damage to melanocytes and their subsequent disappearance in affected skin. There are several pathophysiologic theories; the most prominent are autoimmune, neurohumoral, and autocytotoxic.
Vitiligo has been classified based on clinical grounds into two major forms, segmental vitiligo (SV) and non-segmental vitiligo (NSV), the latter including several variants (generalized, acrofacial and universal).
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.
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.
All patients with vitiligo should be initially treated with medical methods However, after adequate therapeutic trials some lesions remain unchanged and do not repigment as expected, which is when surgical interventions could be used. Surgical therapies used in vitiligo are categorized into either the tissue grafts or the cellular grafts. The tissue grafts are simple ones and used to give good repigmentary results without the need of laboratory and infrastructure, but the disadvantage is that, only limited vitiliginous area can be treated at a time. The cellular grafts are the latest one to be used in vitiligo and include both cultured and non cultured melanocytes and promise to cover wide vitiliginous area in one operative session with limited donor site.
The most commonly used tissue graft is full-thickness punch grafting, where the miniature grafts act as islands of melanocyte reservoir, stimulating perigraft pigment spread. Whereas the essence of cellular grafting is to harvest tissue from a donor site, release individual cells into a suspension, and then transplant them onto deepithelialized recipient skin. This can be easily performed, without the need for a complex technique and the tedious use of trypsin, using the autologous epidermal curettage technique.
The aim of this study was to compare autologous punch grafting with autologous epidermal curettage technique, both followed by narrow band ultraviolet B phototherapy (311 nm) in patients with stable vitiligo, in terms of extent of repigmentation, cosmetic matching, patient satisfaction, complications, cost and ease of the procedure.