Six-year follow-up of vitiligo patients successfully treated with autologous non-cultured melanocyte-keratinocyte transplantation.

BACKGROUND: Although autologous non-cultured melanocyte-keratinocyte transplantation is a treatment option for stable vitiligo, there is lack of long-term maintenance data for this specific treatment. OBJECTIVE: To search for factors associated with long-term maintenance of patients with stable vitiligo successfully treated with melanocyte-keratinocyte transplantation. METHODS: This was a single-centre retrospective study including stable vitiligo patients who underwent successful melanocyte-keratinocyte transplantation in the National Center for Vitiligo, Riyadh, Saudi Arabia, between 1 January 2004 and 30 June 2015. Cox proportional hazard model was used to estimate factors associated with relapse at 6 years of followup. Co-variates included, gender, type of vitiligo, age at vitiligo onset, age at surgical procedure, disease duration, disease stability, affected body surface area, treated surface area, fingertip involvement, type of recipient area treatment and recurrence defined as the onset of new lesions on previously untreated areas. The risk of developing relapse defined as re-appearance of more than 10% depigmentation in a previously treated and repigmented site was considered as the main outcome. RESULTS: In total, 602 patients were included in the study of whom 410 (67%) were women. Mean age was 24.25 years [4.0-67.0]. Affected body surface area of less than 1% (adjusted HR = 0.37; P = 0.04) and mechanical dermabrasion (adjusted HR = 0.26; P = 0.03) were independently associated with lower rates of relapse. On the contrary, non-segmental type of vitiligo (adjusted HR = 2.11; P = 0.03) and fingertip involvement (adjusted HR = 3.75; P = 0.01) were independently associated with higher rates of relapse. CONCLUSIONS: Criteria for selecting patients with stable vitiligo for surgery should include careful assessment of vitiligo type including body surface area of vitiligo and involvement of fingertip before undergoing surgical procedure.

Surgical interventions for vitiligo: an evidence-based review.

BACKGROUND: Vitiligo is a disfiguring disease, characterized frequently by the presence of de-pigmented macules and/or patches. Traditional therapies are essentially medical and are most preferred by dermatologists. Surgical therapies, however, are amongst the most effective interventions for vitiligo but are limited by their invasive nature, as well as the training and expertise needed to perform specific procedures. OBJECTIVES: To assess the evidence for the effectiveness, safety and applicability of the various surgical methods in the treatment of vitiligo. METHODS: For this systematic review of vitiligo surgical therapies, our searches included: PubMed, MEDLINE and Cochrane databases. RESULTS: We reviewed research studies reporting on split thickness skin grafts (STSG), punch/mini-graft, blister roof grafting, cultured and non-cultured cellular transplantation (MKTP). While all methods vary in their repigmentation outcomes, STSG is found to have the highest repigmentation success rate. Overall, post-operative complications included milia, scarring, cobblestone appearance or hyperpigmentation of treated areas. CONCLUSION: This review highlights the need for more randomized controlled trials in this field, underpinned by a more standardized objective approach to the assessment of repigmentation following surgical interventions.

Treatment of vitiligo lesions by ReCell vs. conventional melanocyte-keratinocyte transplantation: a pilot study.

BACKGROUND: Surgical procedures are indicated to treat stable vitiligo, refractory to medical treatment. In addition to conventional surgical techniques, noncultured cellular grafting is gaining wider acceptance among dermatologists. OBJECTIVES: To assess the efficacy of the ReCell kit (Clinical Cell Culture, Cambridge, U.K.) and to compare it with conventional melanocyte-keratinocyte transplantation (MKT) for the treatment of vitiligo. METHODS: Ten lesions in five patients at the same anatomical localization (left vs. right, or two separate lesions at the same anatomical location) were treated with ReCell and conventional MKT and repigmentation compared at 4 months post-transplantation. RESULTS: Of the five lesions treated with ReCell two lesions showed 100%, one 65% and one 40% repigmentation, and one lesion failed to repigment. Of the five lesions treated by conventional MKT three showed 100% and one 30% repigmentation and one failed to repigment. CONCLUSIONS: ReCell may be an effective method to treat vitiligo. Studies on larger series of patients are required to confirm its efficacy. Further research is required to establish the effective dilution of the cell suspension.