A Review of Non-cultured Epidermal Cellular Grafting in Vitiligo

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Abstract

Non-cultured epidermal cellular grafting is an innovative surgical technique that can be used for the treatment of stabilized leucoderma, including vitiligo. Many reports have been published since its introduction in 1992, including several modifications and simplification of the original technique. This systematic review gives an overview of the literature.

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Most cited references 25

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Autologous grafting with noncultured melanocytes: a simplified method for treatment of depigmented lesions.

Y Gauthier, J E Surleve-Bazeille (1992)

Achromic lesions on the trunk and the extremities often do not respond to treatment and little improvement is obtained in cases of segmental vitiligo. Transplantation of autologous noncultured melanocytes was performed to obtain a successful repigmentation. The grafting method is carried out in two steps: production of blisters on the depigmented lesions by freezing with liquid nitrogen and injection in each blister of a suspension of epidermal cells (mainly keratinocytes and melanocytes). The cellular suspension was obtained from samples of skin of the hair scalp after trypsinization. Repigmentation was evident within 25 to 30 days. Coalescence of the pigmented areas was spontaneously observed or obtained after UVA stimulation. Patients with two types of leukoderma-vitiligo or nevus depigmentosus had successful repigmentation after transplantation of autologous noncultured melanocytes. This technique appears to be an effective and simple method for treating patients with achromic areas lacking melanocytes.

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Long-term follow-up of leucoderma patients treated with transplants of autologous cultured melanocytes, ultrathin epidermal sheets and basal cell layer suspension.

Tina M. Olsson, L Juhlin (2002)

In vitiligo and piebaldism the lack of melanin in the epidermis is due to the fact that melanocytes are missing. The patients suffer psychologically and the white areas have lost the part of the skin barrier protection normally provided by the melanocytes. Medical treatments are ineffective in many of the patients, and surgical methods have therefore been developed. It is important to investigate the long-term results and factors that might influence the outcome of melanocyte transplantations in order to form a basis for guidance in the selection of patients who will benefit most from the treatments. A follow-up of 132 patients who had been treated by transplantation on 176 occasions in total, 1-7 years previously, was carried out by questionnaires and clinical examinations. We investigated the responses in five types of leucoderma to three different transplantation methods: autologous cultured melanocytes, ultrathin epidermal sheets and basal layer cell suspension. Stable types of leucoderma, i.e. segmental vitiligo and piebaldism, responded in most cases with 100% repigmentation, regardless of the surgical method used. For these types of leucoderma surgery seems to be the method of choice. The largest group, vitiligo vulgaris, was thoroughly scrutinized and three statistical models were used to analyse the data. The ultrathin epidermal sheet method gave somewhat better overall results, but was the method that gave the worst outcome in knee and elbow areas, emphasizing the importance of the right choice of method depending on the anatomical location to be treated. Irrespective of the method, fingers and elbows were the most difficult areas to repigment. The trunk and the arms and legs (not including elbows and knees) responded best. Patients with increasing and/or extensive vitiligo vulgaris more often showed incomplete repigmentation. They also had a lower chance of retaining their repigmentation compared with those with less extensive vitiligo. Patients in whom untreated white lesions had increased in recent years tended to respond less well to transplantation compared with patients with unchanged or decreased lesions. Within the vitiligo vulgaris group, patients with short disease duration or with small total vitiligo area responded best to transplantation. The subgroup of vitiligo vulgaris patients with hypothyroidism tend to respond less well to the transplantation and they were generally older at vitiligo onset. This information is of great importance for the selection of patients and when informing about the chances of improvement after transplantation. Slight hyperpigmentation was common, especially when ultrathin epidermal sheets had been used. No scars or indurations were seen in treated areas. Transplantations are the methods of choice in stable types of leucoderma. Progressive, widespread vitiligo vulgaris should never be selected for transplantation.

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Double-blind placebo-controlled study of autologous transplanted epidermal cell suspensions for repigmenting vitiligo.

Jean M. Naeyaert, Nanny van Geel, Katia Ongenae … (2004)

To investigate the efficacy of epidermal noncultured cellular grafting in patients with vitiligo and the role of postinflammatory, spontaneous, or UV-induced pigmentation in obtaining repigmentation. A prospective, randomized, double-blind, placebo-controlled study. Ambulatory patients in an institutional practice. Patients were followed up for 3 to 12 months. A total of 33 paired, symmetrically distributed leukodermic lesions, all resistant to therapy, were observed in 28 patients. Nineteen patients appeared to have a stable vitiligo (group 1), whereas there was doubt about the stability of the disease in 9 patients (group 2). After laser ablation, a hyaluronic acid-enriched cellular graft was applied to 1 lesion while the paired lesion received placebo. Three weeks later all lesions were exposed to UV irradiation twice per week for approximately 2 months. Primarily, the percentage of repigmentation was assessed after 3, 6, and 12 months using a digital image analysis system. The repigmentation pattern was also evaluated after 1 and 3 months. A strongly significant difference between cellular grafts and placebo was observed after 3, 6, and 12 months (P<.001, P = .002, and P = .002, respectively). In group 1, repigmentation of at least 70% of the treated area was achieved in 55%, 57%, and 77% of the actively treated lesions 3, 6, and 12 months after treatment, whereas in group 2 repigmentation of at least 70% of the treated area was not observed at any time point. The repigmentation pattern was diffuse in 94% of the responding patients. After a strict preoperative selection for disease stability, transplantation resulted in repigmentation of at least 70% of the treated area in most actively treated vitiligo lesions. Repigmentation was primarily caused by the transplanted melanocytes.

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Author and article information

Journal

Journal ID (nlm-ta): J Cutan Aesthet Surg

Journal ID (publisher-id): JCAS

Title: Journal of Cutaneous and Aesthetic Surgery

Publisher: Medknow Publications (India )

ISSN (Print): 0974-2077

ISSN (Electronic): 0974-5157

Publication date (Print): Jan-Apr 2011

Volume: 4

Issue: 1

Pages: 17-22

Affiliations

Department of Dermatology, Ghent University Hospital, De Pintelaan, Ghent, Belgium

[1 ] Pigment Clinic, National Skin Center, Mandalay Road, Singapore

Author notes

Address for correspondence: Dr. Nanja van Geel, Department of Dermatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail: nanja.vangeel@ 123456UGent.be

Article

Publisher ID: JCAS-4-17

DOI: 10.4103/0974-2077.79181

PMC ID: 3081478

PubMed ID: 21572676

SO-VID: b58c3499-91be-4faa-b76a-771865e1385f

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A Review of Non-cultured Epidermal Cellular Grafting in Vitiligo

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Karger: Dermatology

Most cited references 25

Autologous grafting with noncultured melanocytes: a simplified method for treatment of depigmented lesions.

Long-term follow-up of leucoderma patients treated with transplants of autologous cultured melanocytes, ultrathin epidermal sheets and basal cell layer suspension.

Double-blind placebo-controlled study of autologous transplanted epidermal cell suspensions for repigmenting vitiligo.

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