Simplified non-cultured non-trypsinised epidermal cell graft technique followed by psoralen and ultraviolet a light therapy for stable vitiligo

Abstract

Background and Aims:Stable vitiligo can be treated by various surgical procedures. Non-cultured melanocyte grafting techniques were developed to overcome the time-consuming process of culture while at the same time providing acceptable results. All the techniques using non-cultured melanocyte transfer involve trypsinisation as an integral step. Jodhpur technique used by the author is autologous, non-cultured, non-trypsinised, epidermal cell grafting.Settings and Design:The study was conducted on patients visiting the dermatology outpatient department of a tertiary health centre in Western Rajasthan.Materials and Methods:At the donor site, mupirocin ointment was applied and dermabrasion was done with the help of micromotor dermabrader till pinpoint bleeding was seen. The paste-like material obtained by this procedure containing melanocytes and keratinocytes admixed with the ointment base was harvested with spatula and was subsequently spread over the recipient area. Recipient site was prepared in the same manner by dermabrasion. After 10 days, dressing at both sites was removed taking utmost care at the recipient site as there was a theoretical risk of dislodging epidermal cells.Results:In a study of 437 vitiligo patches, more than 75% re-pigmentation (excellent improvement) was seen in 41% of the patches. Lesions on thigh (100%), face (75%) and trunk (50%) showed maximal excellent improvement, whereas patches on joints and acral areas did not show much improvement.Conclusions:This technique is a simplified, cost effective, less time-consuming alternative to other techniques which involve tryspsinisation of melanocytes and at the same time provides satisfactory uniform pigmentation.

Autologous noncultured, nontrypsinized melanocyte‐keratinocyte graft homogenized in plasma gel followed by narrow‐band ultraviolet B therapy for stable vitiligo: A novel technique

“…The reported complications of the present technique were minor, easy to control, and reported previously 17 . Histopathological examination confirmed the clinical results.…”

“…These results were superior to Kachhawa et al 17 who used jodhpur technique that differs from the current work in application of mupirocin ointment on the skin then doing dermabrasion by micromotor or manual dermabrader to make a paste like material of epidermal cells mixed with mupirocin directly to hold the cells without washing or centrifugation followed by PUVA exposure. Pigmentation started 8‐12 weeks after the procedure and complete repigmentation was attained after 16‐20 weeks.…”

“…Pigmentation started 8‐12 weeks after the procedure and complete repigmentation was attained after 16‐20 weeks. They demonstrated more than 75% repigmentation in 50% of patient 17 . The difference in onset of repigmentation and degree of repigmentation, timing of complete repigmentation, and percentage of patients who got high repigmentation response can be attributed to several differences between the used techniques.…”

“…There was no statistically significant relation between the treatment response and the site of the treated lesions which disagreed with previous studies. 17,37 This can be attributed to the use of different techniques.…”

“…Furthermore, the current study showed no statistically significant relation between the duration of vitiligo and the degree of improvement which agreed with Van Geel et al 38 and Donaparthi et al 39 The reported complications of the present technique were minor, easy to control, and reported previously. 17 Histopathological…”