Long-term Follow-up Study of Segmental and Focal Vitiligo Treated by Autologous, Noncultured Melanocyte-Keratinocyte Cell Transplantation

Abstract

To evaluate long-term efficacy and safety of melanocyte-keratinocyte cell transplantation in the management of segmental and focal vitiligo.Design: A simpler and modified method based on that of OlssonandJuhlinwasperformed.Thismethodusesashaved biopsy skin sample up to one tenth the size of the recipient area. The skin sample is incubated, and the cells are mechanically separated using trypsin-EDTA solution and then centrifuged to prepare a suspension. Cell suspension is then applied to the dermabraded depigmented skin area, and a collagen dressing is applied to keep it in place.Patients: Fifty patients with segmental and 17 with focal vitiligo were treated. One patient with segmental and 2 with focal vitiligo did not attend any follow-up visits. The remaining patients were observed for a period of up to 5 years.Intervention: Autologous, noncultured melanocytekeratinocyte cell transplantation.Main Outcome Measure: Repigmentation was graded as excellent with 95% to 100% pigmentation, good with 65% to 94%, fair with 25% to 64%, and poor with 0% to 24% of the treated area.Results: In the segmental vitiligo group, 41 patients (84%) showed excellent, 3 (6%) good, and 5 (10%) poor pigmentation, which was retained until the end of the respective follow-up period. In the focal vitiligo group, 11 patients (73%) showed excellent, 1 (7%) fair, and 3 (20%) poor pigmentation, which was retained until the end of the respective follow-up period.Conclusions: Melanocyte-keratinocyte cell transplantation is a simple, safe, and effective surgical therapy. Patients with segmental and focal vitiligo can experience a prolonged disease-free period, which may extend through the rest of their lives.

Surgical interventions for vitiligo: an evidence-based review

“…Repigmentation of at least 70% of the treated area was achieved in 77% of actively treated lesions at 12 months after treatment. 37 In another study, excellent repigmentation was achieved in 56% 38 and 84% 35 of patients with generalized vitiligo (Fig. 2a,b) and SV, respectively.…”

“…[26][27][28][29][30][31] The percentage repigmentation reported with cultured techniques ranges from 75-84% in patients with focal vitiligo/SV, to 30-54% in those with generalized vitiligo. 29,30 Noncultured cell transplantation, introduced as a 2-day procedure, 32 was modified by Olsson and Juhlin 33 as a day-care procedure with donor: recipient ratio of 1: 10. van Geel et al 34 added hyaluronic acid to increase the viscosity of the suspension, and Mulekar and colleagues 35,36 simplified the procedure by eliminating all supplements such as fibroblast growth factor and laminar flow bench and replacing carbon dioxide with an ordinary incubator. Repigmentation of at least 70% of the treated area was achieved in 77% of actively treated lesions at 12 months after treatment.…”

A retrospective study of 100 cases of focal vitiligo treated by autologous, noncultured melanocyte-keratinocyte cell transplantation

“…13 In the study by Mulekar it is observed that repigmentation failed to be produced in 20% of focal vitiligo group. 2 In this study 10% of the patients failed to produce any pigmentation. This is a very simple method and can be done on any anatomical location even though the result varies in different areas.…”

“…Vitiligo may be either localized or generalized. Localized vitiligo is further divided into 2 types: (1) segmental vitiligo, which is characterized by unilateral macules in quasi dermatomal distribution (2) focal vitiligo, which is described as depigmented macules in a localized, non dermatomal distribution. 2 Focal vitiligo could be considered an initial stage of generalized or immunologic vitiligo or may be an abortive form of the segmental type.…”

Vitiligo Management- An Update

“…This cell suspension is then applied to the dermabraded vitiligo lesions, and a collagen dressing is applied to keep it in place. A relatively large area of vitiligo, about ten times the size of the donor graft can be taken care of with this procedure 45 . The recipient area however has to be treated with either NB-UVB or PUVA for two to three months to achieve the desired pigmentation.…”