A retrospective study of long term follow-up of 2283 vitiligo patients treated by autologous, non-cultured melanocyte-keratinocyte transplantation.

BACKGROUND: Autologous non-cultured melanocyte-keratinocyte transplantation (MKTP) can be used to treat stable vitiligo cases, but there were insufficient clinical data to evaluate its safety and efficacy. OBJECTIVE: To assess the influence of various factors on the therapeutic outcome of MKTP. METHOD: The single-center retrospective study included stable vitiligo patients who underwent MKTP between June 2009 and June 2018. Univariate and/or multivariable analysis were used to determine the factors affecting the outcome of repigmentation. RESULT: The study comprised 2283 patients who had long-term follow-up data (12-108months). Excellent repigmentation was achieved in 400/606 (66%),788/1341 (58.8%),437/684 (63.9%),18/24 (75%) patients with segmental vitiligo, pre-MKTP phototherapy, younger than 24 years, the lesion on the perineum and scrotum, respectively. However, the patients with a positive family history, Koebner phenomenon responded worse(χ2=29.417, P<0.001; χ2=107.397, P<0.001; respectively). Overall, a significant positive correlation between duration of stability and percentage of repigmentation was found (χ2=42.053, P<0. 001). CONCLUSION: MKTP is efficient and well tolerated for stable vitiligo treatment. Various factors such as duration of disease stability, vitiligo type, family history, site of lesion should be carefully assessed before using MKTP, as it would further improve the post-operative repigmentation.

Subacute cutaneous lupus erythematosus leukoderma treated with melanocyte-keratinocyte transplantation procedure.

Depigmented lesions may occur as postinflammatory sequelae of subacute cutaneous lupus erythematosus (SCLE), leading to great psychosocial impact. A 53-year-old male patient presented with post-SCLE depigmented facial lesions after five years of disease stability. We proposed surgical treatment with melanocyte-keratinocyte transplantation procedure (MKTP), and after five months the patient achieved 90% repigmentation, without Koebner phenomenon (KP). In theory, KP is a possible complication of MKTP procedure since the preparation of the receptor area involves the use of dermabrasion. In an attempt to avoid it, we suggest to maintain the treatment of the underlying disease and wait for a minimum period of disease stability before the procedure.

What's New in Pigmentary Disorders.

Pigmentary disorders are common and can be very distressing to patients. There is a need for better, standardized therapies. The authors review the most recent data for topical, systemic, light, and laser treatments for vitiligo, melasma, and postinflammatory hyperpigmentation. There is a paucity of large-scale, well-designed, randomized, controlled trials for these treatments. Treatment options are often drawn from smaller trials and case series. The treatments described in this article are promising candidates for larger follow-up studies.

The effect of NB-UVB on noncultured melanocyte and keratinocyte transplantation in treatment of generalized vitiligo using two different donor-to-recipient ratios.

BACKGROUND: The melanocyte and keratinocyte transplantation procedure (MKTP) is a safe and effective procedure in treatment of vitiligo. Major advantage of this technique is that a small area of donor skin is needed to cover a large recipient area. To date, there is no consensus on the optimal donor-to-recipient ratio (D/R) required to achieve acceptable repigmentation following melanocyte and keratinocyte transplantation procedure (MKTP) in generalized vitiligo. It has been postulated that the addition of post-transplantation phototherapy may enhance the results. This is first study to assess two different (D/R) ratios with or without adjuvant phototherapy. OBJECTIVE: To compare the repigmentation after MKTP using two different D/R ratios (1/3 and 1/10) with and without adjuvant phototherapy (NB-UVB). METHODS AND MATERIALS: In this non randomized prospective clinical trial, 42 patients with stable generalized vitiligo bilateral and symmetrical in distribution were included. Patients were divided into two groups, 21 patients with a total of 50 lesions were treated with MKTP using a D/R ratio of 1/3 (Group I; 3000 ± 500 cell/mm2 ) and the other 21 patients with a total of 52 lesions were treated by MKTP using a D/R ratio of 1/10 (Group II; 1000 ± 200 cell/mm2 ). To study the role of adjuvant phototherapy on repigmentation, lesions in each patient were divided into two subgroups (a and b): lesions in subgroups Ia and IIa (did not receive NB-UVB) and lesions in subgroups Ib and IIb (received adjuvant phototherapy NB-UVB, two sessions per week for 6 months). The overall grading of repigmentation used was excellent (90%-100% repigmentation), good (75%-89%), fair (50%-74%), and poor (<50%). Also, the percentage of VASI change and color matching were used to assess the results. The study design was approved by the ethical committee of the Faculty of Medicine, Assiut University (IRB attached). RESULTS: The mean percentage of repigmentation was significantly better in group I than group II cases in both areas with or without adjuvant NB-UVB. It was 86.00 ± 16.21 and 87.62 ± 11.66 in subgroups Ia and Ib, respectively, vs 24.14 ± 18.08 and 29.98 ± 16.34 in subgroups IIa and IIb, respectively (P value was 0.000). The percent of excellent response was significantly better in group I than group II. It was 60% and 64% in subgroups Ia and Ib, respectively, and 7.6 and 11.5 in subgroups IIa and IIb, respectively (P value was 0.000). The mean percentage of VASI change was significantly better in group I than group II cases in both areas. It was -90.74 ± 15.84 and -92.06 ± 11.86 in subgroups Ia and Ib, respectively, vs -23.10 ± 32.85 and -26.03 ± 35.15 in subgroups IIa and IIb, respectively (P value was 0.000). The percent of excellent color match was better in group I than group II. It was 84% and 88% in subgroups Ia and Ib, respectively, vs 34.6 in both subgroups IIa and IIb (P < 0.05). A higher density of epidermal cells was transplanted in the recipient area in group I (3000 ± 500 cell/mm2 ) compared to group II (1000 ± 200 cell/mm2 ). There were no statistically significant differences between subgroups (Ia vs Ib and IIa vs IIb) although percentage of repigmentation was slightly better in NB-UVB subgroups. CONCLUSIONS: The higher density of epidermal cells used in the suspension, the higher the percentage of repigmentation obtained. The usage of adjuvant phototherapy following NKMT can enhance the repigmentation response.

Efficacy and safety of noncultured melanocyte-keratinocyte transplant procedure for vitiligo and other leukodermas: a critical analysis of the evidence.

Vitiligo is an acquired pigmentary skin of depigmentation occurring secondary to melanocyte destruction. Vitiligo and other leukodermas have a profound impact on quality of life. Current therapies include medical options, such as phototherapy, topical and systemic corticosteroids, topical calcineurin inhibitors, immunomodulators, and antioxidiants, and surgical options. Surgical options provide melanocytic cells to previously depigmented areas and use either tissue grafting or cellular grafting methods. Topical treatments are often insufficient, and many of the current surgical procedures have shown variable response rates. In this review, we discuss the process of the cellular grafting melanocyte-keratinocyte transplantation procedure (MKTP) and critically analyze its efficacy and safety in the treatment of vitiligo and other leukodermas. PubMed was searched for studies (2001-2017) describing the use of MKTP in patients with vitiligo or other leukodermas. Articles or trials discussing the use of MKTP for these patients were selected for in-depth review. Clinically relevant results regarding efficacy and safety of MKTP in vitiligo and leukoderma patients were analyzed. Numerous trials and case series/reports have demonstrated tolerability and efficacy of MKTP with repigmentation for patients with refractory, stable vitiligo. However, the response rates have been variable, likely influenced by vitiligo type and affected areas. Future research and clinical reporting will provide more insight on which phenotypes may benefit from MKTP.

Combined use of hyperbaric oxygen and sprayed keratinocyte suspension to tackle a difficult wound.

This is the first reported case in the literature to combine the use of a well established therapy to achieve wound healing (ie hyperbaric oxygen treatment) and a novel sprayed keratinocyte suspension technique to treat a challenging wound successfully. The merits and potential issues associated with these treatments are outlined and the case is detailed.

Vitiligo surgical, laser, and alternative therapies: a review and case series.

INTRODUCTION: Vitiligo is a condition caused by the destruction of melanocytes, resulting in areas of skin without pigmentation. While many topical therapies exist for its treatment, not all patients respond to such treatments. Various surgical, laser and other alternative therapies are available for use as well. OBJECTIVE: The objective of this review was to describe the various surgical, laser, and alternative therapies available for vitiligo. A literature review was conducted through Pubmed and Ovid using the search terms "Vitiligo treatment", "Vitiligo surgery", "Vitiligo laser". Since no articles were available about needling on both Pubmed and Ovid using the search criteria, individual articles were sought out through Google. RESULTS: The literature review yielded many possible surgical interventions including autologous mini-punch grafting, suction epidermal blister grafting, split-thickness grafting, and cultured and noncultured melanocyte keratinocyte transfer. Laser options included the helium-neon and xenon-chloride lasers, with tattooing and needling serving as other options. While all the above techniques can provide improvement to pigmentation in vitiliginous patches, physician comfort and experience are important factors with regards to outcome. Our case series of four patients treated with the needling method yielded favorable results, with repigmentation rates ranging from 25-50%, with one patient having 90% repigmentation. CONCLUSION: There are many surgical, laser, and alternative treatment options available for vitiligo when conventional medical therapy fails or for use in conjunction with medical therapies. Autologous mini punch grafting and needling both have minimal equipment requirements and are easy to learn. Physician experience and comfort play a large role in outcome and availability of services.

[Diabetic foot syndrome]. / A diabeteses láb.

Diabetes mellitus contributes to a number of disorders that can affect the quality of life. Amongst this diabetic foot syndrome and diabetic foot ulceration are serious secondary complications of diabetes mellitus. Persons with diabetic foot ulceration have an increased risk of amputation. In the first part of this review the author focuses on the pathophysiology of diabetic foot ulceration. The second part covers the topics of current and future therapies. The reader will understand the need and modes for preventive measures, the importance of multi level education in this topic, and the need for specialized wound care centers. As emphasized by the author, diabetic foot syndrome and ulceration are serious complications of diabetes mellitus, which can lead to devastating lower-extremity amputations and possible death. Specialized wound care centers, multi level education and proper adherence to standard treatment regimes can potentially prevent the need for amputation.

Keratinocyte-melanocyte graft technique followed by PUVA therapy for stable vitiligo.

BACKGROUND: Various surgical procedures for correcting stable vitiligo exist but these have their own limitations. Autologous, non-cultured, non-trypsinized, melanocyte plus keratinocyte grafting is a new and simple method of vitiligo surgery. OBJECTIVE: The study aimed to evaluate efficacy of a new grafting technique in vitiligo patches. METHODS: Eighteen vitiligo patches underwent this procedure. The upper layer of epidermis was removed by superficial dermabrasion using a dermabrader micromotor until the epidermis appeared wet and shiny. Then, antibiotic ointment was applied and dermabrasion was continued up to the whitish area of the upper dermis. The paste-like material (ointment with entangled epidermal particles) was collected and spread over the dermabraded recipient site. RESULTS: Pigmentation usually started at 4-6 weeks. Complete uniform pigmentation took 16-20 weeks. CONCLUSION: For smaller vitiligo patches this method gives cosmetically acceptable results. It is easy to perform and does not require specific laboratory setup.

Hyalomatrix: a temporary epidermal barrier, hyaluronan delivery, and neodermis induction system for keratinocyte stem cell therapy.

Keratinocyte stem cell technology provides at least an adjuvant therapy to clinically close large cutaneous wounds (e.g., burn wounds). Here, the performance of keratinocyte cultures depends primarily on the quality of the bed to which they are applied. Clinical take rates for cultured keratinocyte grafts are optimal when applied to a vascularized dermal bed with minimal bacterial colonization. In the absence of autologous dermis, staged reconstruction with a dermal equivalent or dermal regeneration template is required. A novel product, Hyalomatrix, is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. The scaffold delivers hyaluronan to the wound bed, and the silicone membrane acts as a temporary epidermal barrier. The product has been investigated in a controlled, porcine, acute full-thickness excisional wound model. Cultured autologous keratinocytes (CAKs) were delivered on Laserskin to acute full-thickness wounds treated with Hyalomatrix within chambers, and graft take rates were assessed longitudinally using image analysis. In the absence of chambers, wound contraction was assessed. Clinical CAK take rates fall sequentially with delay in application post-Hyalomatrix pre-treatment, but repeated pre-treatment removed this, with maximal take of 57.2% at 5 weeks post-wounding. In the absence of chambers, more-complete wound closure resulted from edge re-epithelialization and contraction, by a factor of 5 at 1 month, and was achieved at least 2 weeks sooner in the gold standard controls of split-thickness autograft to an acute or pre-treated wound bed. Wound contraction and late neodermal morphology (1 year) were similar in pre-treated CAKs and split-thickness autograft wounds. In this model, the Hyalomatrix wound bed pre-treatment increase in CAK take appeared to be dose dependent. The product appeared to act as a hyaluronan delivery system rather than a dermal regeneration template. The silicone membrane may limit wound bed colonization, and the combination of this temporary barrier with hyaluronan delivery and neodermis induction has been termed a barrier-delivery-induction system. The development of similar systems for serial application offers an alternative to a dermal regeneration template when CAKs are engrafted in the hostile, colonized environment of large burn wounds.

New and experimental treatments of vitiligo and other hypomelanoses.

This article deals with new and experimental treatments that can be used to treat various forms of depigmenting disorders. Ultraviolet B-focused therapies and new surgical approaches are analyzed in this article. These therapies were mainly or only developed to treat vitiligo, which is the most studied and probably the most challenging of all the hypomelanoses, but the results obtained in trials and clinical experiences about vitiligo sometimes can be referred to other depigmenting disorders.

Modified technique of autologous noncultured epidermal cell transplantation for repigmenting vitiligo: a pilot study.

BACKGROUND: Several reports have demonstrated that grafting of autologous melanocytes from normally pigmented donor skin can be used for repigmentation of achromic macules in vitiligo. OBJECTIVE: To investigate a modified approach in which noncultured autologous melanocytes and keratinocytes are grafted on superficially laser dermabraded vitiligo lesions in a suspension enriched with hyaluronic acid. METHODS: Four patients with stable vitiligo were treated using a noncultured melanocyte-keratinocyte suspension. The cellular suspension was grafted on vitiliginous lesions previously dermabraded with a CO2 laser. To improve the viscosity and fixation of the cellular suspension hyaluronic acid was added. Three weeks after grafting, psoralen plus ultraviolet A (PUVA) or ultraviolet B (UVB) therapy was started. Residual leukodermic areas were subsequently retreated. RESULTS: Repigmentation was observed within 2-4 weeks and continued to increase for 3 months after treatment. In all patients, 85-100% repigmentation was achieved. A temporary slight color mismatch was visible in all patients. The most homogeneous repigmentation was obtained 5 months after treatment. CONCLUSION: This modified procedure seems to be a simple and promising treatment for larger vitiliginous areas.

New and emerging therapies for vitiligo.

Vitiligo is a common skin disease; however, it still remains a difficult disease to treat. Not all patients respond to current forms of treatment. There are several new treatments, surgical and nonsurgical, and immunologic, that appear to either have higher success rates than past therapies or have potential as future developments for therapy of vitiligo.

Treatment of postoperative otorrhoea by grafting of mastoid cavities with cultured autologous epidermal cells.

Autologous cultured keratinocyte layers were grafted onto the unepithelialised open mastoid cavities in 8 patients with otorrhoea for 2 to 32 years. All procedures were done on an outpatient basis without anaesthesia, except for local anaesthesia for skin biopsy. The cultured keratinocyte layers adhered well to the bed of granulation tissue lining the mastoid cavity and formed an excellent protective covering of stratified squamous epithelium. All 8 patients have been free from otorrhoea for the 2 to 6 months since grafting.