Subjective and Objective Evaluation of Noncultured Epidermal Cellular Grafting for Repigmenting Vitiligo

Abstract

Background: Noncultured epidermal cell transplantation in vitiligo permits the coverage of relatively large areas without culturing cells. Objective: To investigate the effectiveness of noncultured epidermal cell transplantation in treating stabilized vitiligo using objective and subjective evaluation methods. Methods: Noncultured autologous melanocytes and keratinocytes were grafted in a hyaluronic-acid-enriched suspension on superficially laser-abraded vitiligo lesions in 40 patients with refractory stable vitiligo (30 with generalized and 10 with localized vitiligo). The repigmentation was evaluated 3–12 months after grafting using a digital image analysis system. Furthermore the treatment was evaluated from the patients’ point of view with the DLQI (Dermatology Life Quality Index) and a ‘global assessment’. Results: The mean percentage of repigmentation, evaluated at the last follow-up visit, was 72% (median 84%), and a repigmentation of ≧70% was observed in 62% of patients. The best results were achieved in the neck and the presternal region. A subjective evaluation was performed in half of the subjects. The mean DLQI score at inclusion (6.95, SD = 6.68, n = 20) was significantly decreased after treatment (p = 0.013, mean 3.85, SD = 4.13, n = 20). The patients were satisfied with the achieved result, found it worthwhile to undergo the treatment and would choose it again. Conclusion: According to both subjective and objective evaluation methods, noncultured epidermal cell transplantation is promising in patients with stable vitiligo.

To What Extent Is Quality of Life Impaired in Vitiligo? A Multicenter Study on Italian Patients Using the Dermatology Life Quality Index

“…On the other hand, several studies conducted on Caucasian patients pointed out a small impairment of QoL as well [7,11,25,27,28], whereas the majority of the survey performed on patients with dark skin showed a moderate/very large impairment of QoL [12,13,14,17,18,19,22,23,28]. Two investigations conducted on selected samples of vitiligo patients candidate to use camouflage [15] and attending treatment with noncultured epidermal cellular grafting [16] showed a moderate impairment of QoL in white subjects. In studies in which a control group of healthy subjects/patients affected by other skin diseases was provided, a statistical difference between vitiligo patients and controls was shown [14,17,19].…”

“…Belhadjali et al [17] did not observe any influence of the aforesaid variable on the DLQI score in their sample. Van Geel et al [16] and Parsad et al [12] showed a significant decrease in overall DLQI scores in their patients after a successful therapy, but Kiprono et al [28] and Karelson et al [29] did not. In the present study no significant association was documented between the DLQI mean score and progression of the disease or regression of vitiligo after therapy.…”

“…The aim of this multicenter observational study, carried out in the framework of the Dermatoepidemiology and Evidence-Based Dermatology Study Group of the Italian Association of Hospital Dermatologists, was to study a fairly large sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire, which has been successfully employed for the same purpose on subjects with vitiligo in other countries [7,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]. The DLQI questionnaire is designed for use in adults (i.e.…”

Repigmentation by Outer-Root-Sheath-Derived Melanocytes: Proof of Concept in Vitiligo and Leucoderma

“…Autologous melanocyte transplantation is an option in case of disfiguring, stable vitiligo, but the optimal modality is still debated. So far, the focus has been on procedures of isolation, application and eventually cultivation using interfollicular epidermal melanocytes harvested by skin biopsy from the patient [for reviews, see [1,2,3,4,5,6]]. As for keratinocytes, a stem cell pool resides in the outer root sheath (ORS) of hair follicles also for melanocytes [7], illustrated clinically by the well-known phenomenon of follicular repigmentation in spontaneously healing vitiligo.…”

Benefit Evaluation in Vitiligo Treatment: Development and Validation of a Patient-Defined Outcome Questionnaire

“…In many Asian cultures, vitiligo is even taken as a sign of ‘leprosy’ or ‘uncleanliness’ [10]. Repigmentation is associated with a gain in quality of life [11]. …”