Long-term follow-up of patients undergoing autologous noncultured melanocyte-keratinocyte transplantation for vitiligo and other leukodermas.

BACKGROUND: Persistence of pigmentation after a melanocyte-keratinocyte transplantation procedure (MKTP) is an important consideration for efficacy. OBJECTIVE: We sought to determine long-term repigmentation of MKTP in vitiligo and other leukodermas. METHODS: A retrospective review of electronic medical records was conducted for all MKTPs performed at Henry Ford Hospital between January 2009 and April 2014. Repigmentation was assessed by a 5-point grading scale (poor to excellent) and Vitiligo Area Scoring Index (VASI). RESULTS: One hundred patients had MKTP performed at 236 anatomically-based lesions (ABLs); 63 patients with 157 ABLs had long-term data available (12-72 months; median, 24 months). Segmental vitiligo, nonsegmental vitiligo, and physical leukoderma demonstrated improvement in VASI scores: -75.6 ± 24.6%, -59.2 ± 36.6%, and -32.4 ± 33.5%, respectively. In vitiligo, at 24, 48, and 72 months after MKTP, 53%, 64%, and 53% of ABLs, respectively, maintained >75% repigmentation. Skin phototype, age, and anatomic location of ABLs had no significant effect on the outcome of treatment. LIMITATIONS: Limitations of the study include the retrospective design with uncontrolled, postoperative adjuvant treatments and inconsistent compliance to scheduled follow-up evaluations. CONCLUSIONS: MKTP provides satisfactory long-term repigmentation in the majority of appropriately selected patients with leukoderma. MKTP can maintain repigmentation for at least 72 months.

Repigmentation in vitiligo: position paper of the Vitiligo Global Issues Consensus Conference.

The Vitiligo Global Issues Consensus Conference (VGICC), through an international e-Delphi consensus, concluded that 'repigmentation' and 'maintenance of gained repigmentation' are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation, and the second section summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over 3 yr. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus.

Uncommon responses of segmental vitiligo to melanocyte-keratinocyte transplantation procedure.

BACKGROUND: Patients with segmental vitiligo (SV), unlike those with nonsegmental vitiligo (NSV), have a more predictable course and are more responsive to surgery. OBJECTIVE: To report 10 patients with SV treated with the melanocyte-keratinocyte transplantation procedure (MKTP), who responded with unusual responses not previously reported in the literature. METHODS: This is a retrospective, observational study that reports 10 patients with SV who underwent the MKTP between May 2003 and May 2012. RESULTS: Two patients had successful repigmentation after split-thickness skin grafting after failure of the MKTP. Two patients developed a hypopigmented ring at a margin of the MKTP-treated area. One patient had complete repigmentation after a second MKTP. Two patients developed koebnerization of the recipient site. Three patients developed new vitiligo patches in previously unaffected areas after the MKTP. CONCLUSIONS: Uncommon and even suboptimal responses can occur following the MKTP in SV patients. There is a need for studies to provide better understanding and outcomes for SV patients undergoing the MKTP.

Repigmentation of vitiligo-associated leukotrichia after autologous, non-cultured melanocyte-keratinocyte transplantation.

BACKGROUND: Many cases of leukotrichia are associated with vitiligo. Hair follicles are believed to be the source of melanocytes for skin repigmentation using standard medical therapy for vitiligo. Vitiliginous areas with overlying leukotrichia usually fail to achieve repigmentation by conventional medical treatments as a result of a deficient melanocyte reservoir. Even after the successful repigmentation of vitiliginous skin by medical therapies, leukotrichia hairs may remain depigmented, causing a major psychological impact to the patient. In such cases, surgical treatments may help to achieve the repigmentation of leukotrichia hairs. Reports of successful repigmentation in leukotrichia using different surgical treatments for vitiligo are few. OBJECTIVE: This study reports the benefit of autologous non-cultured melanocyte-keratinocyte transplantation (MKT) in patients with vitiligo-associated leukotrichia. METHODS: We report four cases of vitiligo-associated leukotrichia treated with MKT. RESULTS: All four patients showed significant repigmentation in vitiligo-associated leukotrichia after MKT. CONCLUSIONS: Melanocyte-keratinocyte transplantation may represent a good therapeutic option for the repigmentation of vitiligo-associated leukotrichia. This series includes only four responsive cases. Larger prospective studies are needed to determine the true response rate and mechanism of repigmentation.

Melanocyte-keratinocyte transplantation procedure in the treatment of vitiligo: the experience of an academic medical center in the United States.

BACKGROUND: Vitiligo is a disfiguring disease with limited treatment options. Surgical treatment is underused in the United States because of perceived risk of infection, costs, and difficulty of the procedure. OBJECTIVE: We sought to determine the efficacy and safety of the melanocyte-keratinocyte transplantation procedure (MKTP) in an academic dermatology department in the United States. METHODS: This prospective, uncontrolled, open-label study enrolled patients aged 18 years or older with a self-reported history of vitiligo and no new or expanding lesions for at least 6 months before surgery. Patients with a history of koebnerization or keloid formation were excluded. Patients underwent autologous MKTP. Repigmentation during a 3- to 6-month follow-up period was assessed categorically and by modified Vitiligo Area Scoring Index. Safety was assessed by frequency of adverse events. RESULTS: Of the 28 patients who underwent 36 procedures, 23 patients who underwent 29 procedures completed the 3- to 6-month follow-up period. Data for these 29 procedures show excellent repigmentation (ie, 95%-100%) after the MKTP in 17%, and good repigmentation (ie, 65%-94%) in 31%. Fair (64%-25%) and poor (24%-0%) repigmentation were achieved in 10% and 41% of patients, respectively. Average percent change in Vitiligo Area Scoring Index was -45% (95% confidence interval -64% to -26%), signifying an improvement in pigmentation. LIMITATIONS: Limitations include small sample size and lack of a control group. CONCLUSIONS: The MKTP is an effective and well-tolerated procedure based upon categorical and Vitiligo Area Scoring Index assessments of repigmentation.

Nevus depigmentosus treated by melanocyte-keratinocyte transplantation.

BACKGROUND: Nevus depigmentosus is a congenital, nonprogressive hypopigmented disorder. Various therapeutic methods have been attempted to repigment nevus with variable results. OBJECTIVE: The objective of this study is to report our experience of treatment of nevus depigmentosus with a combination of noncultured melanocyte-keratinocyte transplantation (MKTP) and excimer laser sessions. MATERIALS AND METHODS: Six patients (male 1, female 5) of nevus depigmentosus were treated with a combination of noncultured melanocyte-keratinocyte transplantation and excimer laser. One patient was lost to follow-up. Remaining five patients were observed for a period ranging from 7 to 30 months. RESULTS: Two patients responded poorly to MKTP. The remaining three patients responded with repigmentation ranging from 80% to 100% but the quality of repigmentation was unsatisfactory in two of them. CONCLUSION: Though repigmentation of nevus depigmentosus is possible by grafting techniques, the results are inconsistent and recurrence is possible.

Quality of life in saudi vitiligo patients.

BACKGROUND: Vitiligo has a devastating psychosocial effect. The cultural traditions of Saudi society are quite different compared with the western world. Hence, a quality of life study using a different questionnaire suitable to the cultural traditions of the society is necessary to measure qualify of life in vitiligo patients. OBJECTIVE: This study was conducted to assess the quality of life (QOL) in Saudi vitiligo patients and their family. MATERIALS AND METHODS: A prospective cross-sectional study at National Center for Vitiligo and Psoriasis, Saudi Arabia. A validated Arabic questionnaire of 41 questions was developed and utilized specifically for this study. Arabic language instrument was distributed to 260 vitiligo patients. Scores were compared in relation to demographic, clinical, and social variables in 4 dimensions of scale (relationship with colleagues, family relationship, social relationship, and self respect). RESULTS: Overall score QOL was 17.1. Mean score for males was 11.1, whereas that for females was 23.9 (P < 0.05). Females scored significantly higher in all the 4 dimensions. Patients with exposed disease lesions scored significantly higher than those with unexposed lesions 5 vs 3.4 (P < 0.05). CONCLUSION: The overall score of QOL in vitiligo is relatively high, indicating a negative impact of the disease on QOL. QOL in women is significantly more affected than in men.

Treatment of post-burn leucoderma with non-cultured melanocyte-keratinocyte transplantation (MKTP).

INTRODUCTION: Deep burns often result in hypo-pigmentation, referred to as leucoderma which has a similar psychosocial impact on the patients as that of vitiligo. Several tissue grafting methods have been reported to treat post-burn leucoderma. METHODS: A simple method consisting of harvesting a donor skin sample, preparation of an epidermal cell suspension and the transplantation of the cell suspension on to a dermabraded recipient area, was performed in a clean procedure room. No special laboratory set-up was used for the cell separation procedure. Patients were treated with 18 sessions of excimer laser starting 1 month post-operatively, to hasten the repigmentation. OBSERVATION: Of the 10 patients treated with MKTP, 3 were lost to follow-up. The remaining 7 patients showed repigmentation ranging from 90% to 100% with good color matching. CONCLUSION: MKTP is an effective method to treat post-burn leucoderma. No special precautions are required to treat any anatomical site or uneven scarred surface.

Childhood vitiligo: a long-term study of localized vitiligo treated by noncultured cellular grafting.

Segmental type was the second most commonly reported in childhood vitiligo. No significant difference has been reported in the prevalence of childhood and adult focal vitiligo. However, the prevalence of segmental vitiligo has been found to be higher in children compared with that in adults. All available medical and phototherapy options are limited by adverse effects or unsatisfactory efficacy. Surgical techniques may be preferred but are not recommended for children as they are time consuming and associated with technical difficulties. In a retrospective review, 25 children aged 4 to 16 years were treated by autologous, noncultured cellular grafting performed under sedation supplemented with local anaesthesia and were followed up for a period of 9 to 54 months postgrafting. 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. In the segmental group, eight (62%) showed excellent, two (15%) good, one (8%) fair, and two (15%) poor pigmentation, which was retained until the end of the respective follow-up period. In the focal group, nine (75%) showed excellent, and one (8%) each showed good, fair, and poor pigmentation, which was retained until the end of the respective follow-up period. Noncultured cellular grafting may be considered to treat childhood localized vitiligo.

Treatment of vitiligo on difficult-to-treat sites using autologous noncultured cellular grafting.

BACKGROUND: Because of the limitations of medical treatment, various surgical therapies have been developed and are being accepted to treat vitiligo. However, certain areas such as the fingers and toes, palms and soles, lips, eyelids, nipples and areolas, elbows and knees, and genitals are considered difficult-to-treat areas. OBJECTIVE: To evaluate data pertaining to individual sites considered to be difficult to treat and highlight that noncultured melanocyte-keratinocyte transplantation (MKT) does not require any special precautions to treat these anatomical sites. METHODS AND MATERIALS: Forty patients (13 male and 27 female) with bilateral vitiligo and nine (4 male and 5 female) with unilateral vitiligo were treated using noncultured MKT, for "difficult-to-treat" sites at the National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia, and were analyzed for response according to region. 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: For bilateral vitiligo, more than 50% of patients treated for difficult sites showed more than 65% repigmentation of the treated areas. For unilateral vitiligo, all of the patients except for two treated for the eyelids showed more than 65% repigmentation of the treated area. CONCLUSIONS: The concept of a "difficult-to-treat site" is a relative term and depends upon the technique used. The noncultured MKT does not require any special precautions to treat these anatomical sites. This review may help physicians to change the concept of "difficult-to-treat site."

Treatment of halo nevus with a 308-nm excimer laser: a pilot study.

BACKGROUND: The treatment of halo nevus is controversial and ranges from observation requiring no therapy to excision biopsy. OBJECTIVE: To assess the efficacy of excimer laser for the treatment of halo nevus. METHODS: Four patients with halo nevus on the face were treated by excimer laser three times a week until they achieved 75% pigmentation or a maximum of 36 treatment sessions. They were assessed visually by comparing photographs taken before and at the end of treatment. RESULTS: Two patients re-pigmented completely and two showed 80% pigmentation. The number of sessions ranged from seven to 35. The study is limited by the small number of patients. CONCLUSION: Treatment with the 308-nm excimer laser may be an effective treatment of halo nevi located on the face.

Stable vitiligo treated by a combination of low-dose oral pulse betamethasone and autologous, noncultured melanocyte-keratinocyte cell transplantation.

BACKGROUND: Various surgical procedures are in use to treat stable vitiligo. The possibility of Koebner phenomenon always exists with surgical treatment. Partial or complete failure to repigment is observed in spite of clinical stability. AIM: To evaluate the usefulness of a combination treatment of low-dose oral betamethasone and melanocyte-keratinocyte transplantation. METHODS: Oral betamethasone was given to patients who failed to respond either completely or partially to melanocyte-keratinocyte cell transplantation, and the procedure was repeated for previously treated and nontreated area. A simpler and modified method described by Mulekar was performed. RESULTS: Seventeen patients with vitiligo vulgaris and eight patients with segmental vitiligo were retransplanted after giving oral betamethasone for 2 to 10 months after the initial procedure. Two patients of vitiligo vulgaris and one of segmental vitiligo failed to respond completely even after repeat transplantation. Fifteen vulgaris and seven segmental patients showed excellent to good repigmentation after repeat transplantation. CONCLUSION: Combined treatment of oral betamethasone and melanocyte cell transplantation has a potential to produce complete repigmentation in patients with large vitiliginous areas.

Mixed vitiligo.

BACKGROUND: There are two commonly recognized forms of vitiligo-generalized and localized. This classification is important to understand the course of the disease and its prognosis. Most patients have generalized vitiligo; few patients have both segmented and generalized vitiligo. OBSERVATION: We report four more cases of mixed vtiligo, segmental with generalized type. This report is only the second to present a case of segmental with generalized vitiligo. CONCLUSION: Mixed vitiligo is not yet part of a standard classification. Its etiology is not yet fully defined. Further research is required to understand the course and prognosis of mixed vitiligo.

Genital vitiligo treated by autologous, noncultured melanocyte-keratinocyte cell transplantation.

BACKGROUND: Genital vitiligo is common and has a deleterious effect on the psychosexual function of patients. It is well known that glabrous skin (non-hair-bearing skin such as below the ankles, genitalia, lips, distal ends of fingers) rarely responds to the therapy unless it has some residual pigment. OBJECTIVE: The objective was to report genital vitiligo treated successfully by autologous, noncultured, melanocyte-keratinocyte cell transplantation. METHODS: Three cases of clinically stable genital vitiligo were treated by autologous, noncultured melanocyte-keratinocyte cell transplantation. RESULTS: All lesions treated repigmented almost completely. All patients were very satisfied with the excellent cosmetic results. CONCLUSION: Autologous, noncultured melanocyte-keratinocyte cell transplantation may be an effective surgical treatment for management of genital vitiligo.

Long-term follow-up study of 142 patients with vitiligo vulgaris treated by autologous, non-cultured melanocyte-keratinocyte cell transplantation.

BACKGROUND: Vitiligo vulgaris patients are difficult to treat surgically owing to large area involvement. Larger areas can be treated with the help of in vitro cultured melanocytes. These techniques are complex. In most of the studies published to date the number of patients reported is low and follow-up period short. OBJECTIVE: To evaluate long-term efficacy and safety of melanocyte-keratinocyte cell transplantation in large number of vitiligo vulgaris patients. METHODS: A simpler and modified method based on that of Olsson and Juhlin has been used. It uses shave biopsy skin sample up to 1/10th the size of recipient area. Skin sample is incubated, cells mechanically separated using trypsin-EDTA solution, and then centrifuged to prepare a suspension. Cell suspension is then applied to a dermabraded de-pigmented skin area and collagen dressing given to keep it in place. RESULTS: One hundred and forty-two patients with vitiligo vulgaris were treated and observed for a period up to 6 years. Eighty (56%) patients showed excellent, 15 (11%) showed good, 13 (9%) showed fair and 34 (24%) showed poor repigmentation, which was retained till the end of the respective follow-up period.