Evaluation of treatment response to autologous transplantation of noncultured melanocyte/keratinocyte cell suspension in patients with stable vitiligo

Abstract

BackgroundVitiligo is a chronic disease characterized by the appearance of achromic macules caused by melanocyte destruction. Surgical treatments with melanocyte transplantation can be used for stable vitiligo cases. ObjectivesTo evaluate treatment response to the autologous transplantation of noncultured epidermal cell suspension in patients with stable vitiligo.MethodsCase series study in patients with stable vitiligo submitted to noncultured epidermal cell suspension transplantation and evaluated at least once, between 3 and 6 months after the procedure, to observe repigmentation and possible adverse effects. The maximum follow-up period for some patients was 24 months.ResultsOf the 20 patients who underwent 24 procedures, 25% showed an excellent rate of repigmentation, 50% good repigmentation, 15% regular, and 10% poor response. The best results were observed in face and neck lesions, while the worst in extremity lesions (88% and 33% of satisfactory responses, respectively). Patients with segmental vitiligo had a better response (84%) compared to non-segmental ones (63%). As side effects were observed hyperpigmentation of the treated area and the appearance of Koebner phenomenon in the donor area.Study limitationsSome limitations of the study included the small number of patients, a subjective evaluation, and the lack of long-term follow-up on the results. CONCLUSION: Noncultured epidermal cell suspension transplantation is efficient and well tolerated for stable vitiligo treatment, especially for segmental vitiligo on the face and neck.

Autologous non-cultured melanocyte–keratinocyte transplantation in the treatment of vitiligo: patient selection and perspectives

“…Similarly, lesions over the joints including elbows, knees and ankles tend to respond less favorably with <30% of the lesions showing excellent repigmentation. 5 , 7 , 26 , 28 – 30 , 43 Lesions over the joints showed a significantly lower response compared with presternal lesions and those on the trunk and extremities. 6 On the contrary, some authors reported an excellent response of lesions overlying joints with ≥95% repigmentation achieved in 54% of lesions in one study 4 and in 100% of lesions in others.…”

“…SV cases showed a significantly better response than NSV with 85% vs 70% repigmentation ( P =0.011) in one study 6 and >50% repigmentation in 88% vs 71% of cases in another study ( P =0.007). 40 Other studies reported a better response in SV cases, although statistical analysis was not performed 2 , 3 , 8 , 26 , 28 , 43 or was not significant. 13 , 38 Immunological disturbances probably interfere with the outcome of transplantation in GV.…”

“…Several authors excluded cases with widespread vitiligo involving >30% of the body surface area. 2 , 37 , 43 The probability of a successful transplantation outcome to non-cultured epidermal suspension (NCES), ultrathin sheet transplantation and cultured epidermal suspension (CES) was found to be 20 times higher (OR) in patients with <100 cm 2 white areas, three times higher in the 101–500 cm 2 group and two times higher in the 501–1,500 cm 2 group, compared with patients with >1,500 cm 2 white area. 28 Similarly, a negative correlation was found between Vitiligo Area Scoring Index, and Vitiligo European Task Force area and stage scores and percentage repigmentation in a more recent study.…”

“… 6 , 27 Many studies included children and adolescents in the treated cases. 2 , 5 , 6 , 8 , 17 , 25 , 27 , 30 , 31 , 34 , 36 , 38 , 41 , 43 , 46 Two studies focused solely on the treatment outcome in this age group. Mulekar et al 25 treated 25 children and adolescents using general anesthesia with ≥95% repigmentation in 8/13 SV and 7/12 focal vitiligo cases.…”

“…Recipient vitiligo skin may be prepared by different methods including cryoblebbing, 7 , 29 , 30 , 47 dermabrasion 2 – 4 , 8 , 15 – 18 , 25 – 28 , 33 – 38 , 41 , 43 , 44 , 46 , 51 or laser resurfacing. 5 , 9 , 29 , 40 , 45 , 52 , 53 The ideal method should be simple to perform, safe with minimal side effects and efficient reaching the dermoepidermal junction to avoid scarring or loss of the grafted melanocytes.…”