Efficacy of Transplantation of Combination of Noncultured Dermal and Epidermal Cell Suspension vs Epidermal Cell Suspension Alone in Vitiligo

Abstract

IMPORTANCE Surgical interventions, notably noncultured epidermal suspension (NCES), are the next line of treatment in patients with vitiligo who fail to respond to medical therapy. Noncultured epidermal suspension is usually performed in patients with vitiligo with duration of clinical stability (DS) of 12 months or longer because DS is a vital parameter in determining outcome of NCES. In this pilot study, we planned to assess the efficacy of a novel combination of noncultured epidermal cell suspension and noncultured dermal cell suspension (NCES and NDCS) in patients with vitiligo with shorter DS (3-6 months). OBJECTIVE To compare the efficacy of transplantation of NCES and NDCS vs NCES alone in patients with vitiligo with DS of 3 to 6 months. DESIGN, SETTING, AND PARTICIPANTS A single-center randomized clinical trial including 40 patients with focal, segmental, or generalized vitiligo with DS of 3 to 6 months or more than 12 months was carried out. Based on DS, 2 groups including 20 patients each were recruited (DS in group 1, 3 to 6 months; DS in group 2, more than 12 months). Each group was further randomized into 2 subgroups, A and B. INTERVENTION Patients in subgroups 1A and 2A underwent NCES alone, whereas patients in subgroups 1B and 2B underwent NCES and NDCS. MAIN OUTCOMES AND MEASURES Extent of repigmentation, color match, and pattern of repigmentation at 24 weeks. RESULTS Of the 40 study participants, mean (SD) age was 24.9 (4.0) years and 24 (60%) were women; in group 1 with DS for 3 to 6 months, more than 75% repigmentation at 24 weeks was observed in all 10 patients in subgroup 1B (NCES and NDCS) compared with 3 of 10 patients in subgroup 1A (NCES) (100% vs 30%, P = .003). In group 2 (DS > 12 months), the same was observed in 6 of 10 patients in subgroup 2A and 7 of 10 patients in subgroup 2B (NCES) (60% vs 70%, P > .99). The 2 groups and subgroups did not show any significant differences with respect to color matching and pattern of repigmentation. CONCLUSIONS AND RELEVANCE Combination of NCES and NDCS resulted in excellent response in patients with vitiligo with shorter duration of clinical stability compared with NCES alone. This combination may be used early in the course of stable vitiligo without waiting for a period of 12 months or more since last clinical activity.

Regenerative Medicine of Epithelia: Lessons From the Past and Future Goals

“…A comparative study between autologous non-cultured epidermal cell suspension transplantation and its combination with non-cultured dermal cell suspension was carried out as a randomized clinical trial ( NCT03013049 ) on 40 patients with stable vitiligo. This study suggested that the combined approach was more effective than the use of non-cultured epidermal cell suspension alone in patients with vitiligo stable from 3 to 6 months ( Thakur et al, 2019 ). However, the efficacy of this novel approach has yet to be confirmed in the long term.…”

“…However, the efficacy of this novel approach has yet to be confirmed in the long term. Indeed, a large cohort of patients and a long follow-up are needed to confirm the stable repigmentation, as well as a comparative study between this approach and the transplantation of cultured epidermal autografts ( Thakur et al, 2019 ).…”

Vitiligo: Translational research and effective therapeutic strategies

“…Dermal mesenchymal cells have shown immunomodulatory effects in vitiligo and a study comparing non‐cultured dermal cell suspension in combination with NCES showed good repigmentation in vitiligo with the stability of 3–6 months as compared to NCES alone. (Thakur et al., 2019) Combination of NCES with follicular stem cells and platelet‐rich plasma has also shown good efficacy in studies. (Parambath et al., 2019; Razmi et al., 2018) Advantages of these methods include coverage of large areas in single sitting, good cosmetic outcomes with the excellent color match.…”

Skin seeding technique with 0.5‐mm micropunch grafting for vitiligo irrespective of the epidermal–dermal orientation: Animal and clinical studies

“…Surgical interventions for vitiligo include punch grafting, suction blister grafting and cellular grafting 7 . While autologous non‐cultured epidermal cell suspension transplantation has gained popularity in recent years, 8,9 punch grafting remains the simplest and most readily available technique for small vitiligo lesions 10 . It has often been noted that punch grafting is time‐consuming and less efficient, and that it involves a risk of cobblestoning.…”

“…7 While autologous non-cultured epidermal cell suspension transplantation has gained popularity in recent years, 8,9 punch grafting remains the simplest and most readily available technique for small vitiligo lesions. 10 It has often been noted that punch grafting is time-consuming and less efficient, and that it involves a risk of cobblestoning. However, the introduction of motorized 0.8-mm micropunch grafting has remarkably reduced the procedure time and improved the final outcome while minimizing the incidence of cobblestoning.…”