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ElGhareeb MI, Kandeel AH, Attia SA. Combination of autologous FCS and MPG versus each technique alone in the treatment of stable vitiligo. Arch Dermatol Res 2024; 316:358. [PMID: 38850293 PMCID: PMC11162356 DOI: 10.1007/s00403-024-03045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 06/10/2024]
Abstract
Follicular cell suspension (FCS) transplantation is a novel surgical method for treating resistant stable vitiligo, whereas mini punch grafting is an established effective method for treating stable vitiligo. The combination of FCS and mini punch grafting is a better strategy for the treatment of resistant stable vitiligo. The aim of the study was to evaluate the efficacy of follicular cell suspension, mini punch grafting, and a combination of both techniques in the treatment of stable vitiligo. This prospective comparative study was conducted on 48 patients with stable vitiligo. They were divided into three equal groups, including group A (treated with follicular cell suspension), group B (treated with mini punch grafting), and group C (treated with the combination of both techniques). All patients were followed-up for six months for the assessment of their therapeutic response regarding clinical outcomes. By comparing the data of the three studied groups, we found that the difference in the degree of re-pigmentation after one and three months of treatment was not significant. However, the progress of re-pigmentation was significantly different after six months of treatment among the three studied groups (P = 0.027). Specifically, re-pigmentation was significantly better in group C than in groups A and B (P = 0.037 and 0.017, respectively), but it was not significantly different between groups A and B.
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Shi X, Wang F, Sun Y, Du J, Ding X. Long-Term Effects and Prognosis Following Suction Blister Epidermal Grafting in Vitiligo Patients. J Cutan Med Surg 2024; 28:264-268. [PMID: 38481106 DOI: 10.1177/12034754241238717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Suction blister epidermal grafting (SBEG) is currently one of the most prevalent surgical methods for stable vitiligo. OBJECTIVE To investigate the long-term outcomes of vitiligo patients who underwent SBEG and to explore risk factors associated with postoperative relapse. METHODS A retrospective cohort study was conducted in patients who underwent SBEG in our department between January 2016 and December 2022. Treatment outcomes, including repigmentation rate, adverse events, and postoperative relapse, were surveyed via telephone interview or out-=patient visit. Multivariate logistic regression models were used to assess the potential risk factors for postoperative relapse. Statistical significance was assumed at P < .05. RESULTS A total of 253 patients were included with a repigmentation rate of 96% (243/253) after grafting. Common adverse events included cobblestone-like appearance (73.1%, 185/253) in the donor site, perigraft halo (46.2%, 117/253), and cobblestone-like appearance (26.1%, 66/253) in the recipient site. Postoperative relapse occurred in 20.1% of patients over a mean time of 29.7 months after grafting. Nonsegmental type of vitiligo and coexistence of autoimmune diseases were risk factors for postoperative relapse. CONCLUSION SBEG is an effective surgical treatment for vitiligo with high repigmentation rate and good safety profile. Nonsegmental vitiligo and comorbid autoimmune diseases may increase the risk of postoperative relapse.
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Shahbazi A, Zargar SJ, Aghdami N, Habibi M. The story of melanocyte: a long way from bench to bedside. Cell Tissue Bank 2024; 25:143-157. [PMID: 37046149 DOI: 10.1007/s10561-023-10081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/23/2023] [Indexed: 04/14/2023]
Abstract
Skin is composed of major layers, namely a superficial epidermis and a deeper dermis. The color of skin is influenced by a number of pigments, including melanin, which is produced by cells called melanocytes. Most skin disorders are relatively benign, but a few, including melanomas, can be fatal. A number of more noticeable disorders, namely albinism and vitiligo, affect the appearance of the skin and its accessory organs. Vitiligo is associated with significant psycho-social morbidity and a major effect on quality of life. Topical steroids, calcineurin inhibitors, phototherapy and surgery are the most common treatments for melanoma. However, there are many patients who do not respond to any of these modalities. The transplantation of cultured or non-cultured melanocyte is the most important treatment for hypopigmentory disorders. This study aims at reviewing the history of melanocyte cultivation, and evaluating the effectiveness of transplantation of cultured cells. For this purpose, the authors examined the initial process of isolation, characterization, and transplantation of epidermal cells. This review, thus, summarizes the current understanding of the cutaneous pigmentary system from the start of synthesis in the pigment cells, along with the response of repigmentation. During the production of melanin, melanosomes are transferred to neighboring keratinocyte in order to form perinuclear melanin caps. The objective of this review is to analyze the melanocytes transplantation in the last century to date, and explore the methods epidermal cells can increase pigmentation in hypo-pigmented areas in skin disorders. Moreover, the focus is on the story of the melanocyte back to 1950s. In addition, prior systemic therapy was associated with a significant increase, based on combined additional therapy, achieving desired results and improved outcomes. Despite the short study of a long way of melanocyte assessment and following up patient treatment, results of the all reports confirmed the efficacy of the method used in the treatment of stable vitiligo patients, who did not respond to the common algorithms of non-invasive treatments.
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Pundir A. Old Is Gold! Outcome of Mini Punch Grafting Using Cyanoacrylate Glue in Female Genital Vitiligo. Dermatol Surg 2024; 50:314-316. [PMID: 38048179 DOI: 10.1097/dss.0000000000004029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
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Zhou Y, Gao T, Li C, Jian Z. Q-switched ruby laser for depigmentation: A feasible modality to treat vitiligo universalis in children. Indian J Dermatol Venereol Leprol 2024; 90:115-117. [PMID: 37436020 DOI: 10.25259/ijdvl_36_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/13/2023] [Indexed: 07/13/2023]
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Gupta S, Jangra RS, Khatri M, Gupta S. Ballooned glove for smooth epidermal graft transfer in vitiligo. J Am Acad Dermatol 2024; 90:e7-e8. [PMID: 35307490 DOI: 10.1016/j.jaad.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022]
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Uitentuis SE, Lommerts JE, Willemsen M, Willemsen K, de Rie MA, Luiten RM, Bekkenk MW, Wolkerstorfer A. Addition of cell suspension transplantation to UVB and topical treatment in non-segmental vitiligo: a randomized controlled study. Int J Dermatol 2024; 63:e4-e6. [PMID: 37965775 DOI: 10.1111/ijd.16900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
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Yousif J, Ceresnie MS, Hamzavi IH, Mohammad TF. Practical guidelines for the treatment of vitiligo with the melanocyte-keratinocyte transplantation procedure. Arch Dermatol Res 2023; 316:10. [PMID: 38038734 DOI: 10.1007/s00403-023-02761-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 08/24/2023] [Accepted: 09/16/2023] [Indexed: 12/02/2023]
Abstract
Vitiligo manifests as depigmented macules and patches on the skin and can significantly impact a patient's quality of life. Despite the availability of several treatment modalities, rates of repigmentation can vary widely among individuals and disease subtypes. For patients with stable vitiligo who have not achieved satisfactory results with medical treatments, the melanocyte-keratinocyte transplantation procedure (MKTP) is a viable option. While variations of this autologous non-cultured cellular grafting procedure are performed by dermatologic surgeons worldwide and has shown good tolerability and effectiveness, it remains under utilized in the United States. We present a comprehensive overview of MKTP, highlighting evidence-based and practical techniques to enhance patient outcomes. By serving as a valuable resource, this review aims to support dermatologic surgeons seeking to incorporate MKTP into their practice and promote awareness regarding its benefits, ultimately fostering a more comprehensive approach to vitiligo care.
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Wu Y, Wang T, Song X, Xu A, Dai Y. Treatment of perioral vitiligo with a combination of upper hair follicle transplantation and the application of a 308 nm excimer laser. Skin Res Technol 2023; 29:e13547. [PMID: 38115595 PMCID: PMC10730977 DOI: 10.1111/srt.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
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Ashique KT, Jayasree P, Kaliyadan F. A multipurpose handle for vitiligo surgery and beyond. Indian J Dermatol Venereol Leprol 2023; 89:923-924. [PMID: 37609753 DOI: 10.25259/ijdvl_996_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/13/2023] [Indexed: 08/24/2023]
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Souroujon AA, Guttman I, Levin N, Capuano G, Reyes Salcedo CA, García P. Autologous cell transplant as a treatment for stable segmental vitiligo: a systematic review. Int J Dermatol 2023; 62:1324-1331. [PMID: 37715361 DOI: 10.1111/ijd.16844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE This systematic review provides a comprehensive analysis of the efficacy of autologous cell transplant as a therapeutic approach for stable segmental vitiligo. Vitiligo poses significant challenges for healthcare professionals in terms of treatment selection. Autologous cell transplant has emerged as a promising modality for managing vitiligo, with cultured and noncultured transplants being considered when determining the patient's treatment approach. There is little knowledge and literature on the subject, so we analyze the different studies. METHOD Using online medical literature databases and the PRISMA guidelines, six out of 60 articles met the acceptance criteria to be analyzed, emphasizing the lack of current literature on this subject. RESULTS Autologous cell transplant achieves excellent pigmentation rates for many body parts. We found that cultivated cells had better results than noncultivated ones. Both types of treatments could pigment 80% or more where needed. CONCLUSION This review highlights the importance of autologous cell transplant as a new and reliable tool for the treatment of stable segmental vitiligo, cultured transplants being the most effective. By employing autologous cell transplant, the repigmentation rate is notably high and consistently achievable. Although its cost and logistical complexities hinder the current accessibility to this therapy, efforts are being made to enhance its availability, and its scope is expected to expand further. More studies are needed to understand this therapy method in other kinds of vitiligo.
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Refat MA, Strassner JP, Frisoli ML, Rashighi M, Richmond J, Nada E, Saleh R, El-Hamd MA, Goldberg D, Mahmoud BH, Harris JE. Lesional CD8+ T-Cell Number Predicts Surgical Outcomes of Melanocyte-Keratinocyte Transplantation Surgery for Vitiligo. J Invest Dermatol 2023; 143:2275-2282.e6. [PMID: 37478900 PMCID: PMC11140410 DOI: 10.1016/j.jid.2023.03.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 07/23/2023]
Abstract
The melanocyte-keratinocyte transplantation procedure (MKTP) treats stable and recalcitrant vitiligo. Despite careful selection of candidates based on clinical stability, the success of the procedure is unpredictable. The aim of our study was to define the immunological profile of stable vitiligo lesions undergoing MKTP and correlate them with clinical outcomes. We included 20 MKTP candidates with vitiligo and a patient with piebaldism as a control. Prior to MKTP, T-cell subsets and chemokines in the recipient skin were measured by flow cytometry and ELISA. During MKTP, melanocytes in the donor skin were quantified by flow cytometry. After MKTP, patients were followed for 12 months and repigmentation was assessed clinically and by ImageJ analysis of clinical photographs. Baseline immunologic biomarkers, duration of clinical stability, and transplanted melanocyte number were correlated to postsurgical repigmentation scores. CD8+ T cells were elevated in 43% of the clinically stable vitiligo lesions. CD8+ T-cell number negatively correlated with postsurgical repigmentation scores (r = -0.635, P = 0.002). Duration of clinical stability, skin chemokines, and transplanted melanocyte number did not influence postsurgical repigmentation. This study demonstrates that CD8+ T-cell number correlates negatively with success of postsurgical repigmentation and can be a biomarker to identify ideal surgical candidates.
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Rajput L, Kharghoria G, Patel U, Gupta S. Chemically assisted gauze abrasion: An economical and convenient alternative to mechanical dermabrasion in vitiligo surgery. J Am Acad Dermatol 2023; 89:e141-e142. [PMID: 34333077 DOI: 10.1016/j.jaad.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022]
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Abdel Halim DM, Fekry A, Mogawer RM. The value of adding platelet-rich plasma (PRP) to noncultured epidermal cell suspension (NCECS) in surgical treatment of stable resistant vitiligo: A self-controlled randomised double-blinded study. Australas J Dermatol 2023; 64:359-367. [PMID: 37228170 DOI: 10.1111/ajd.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Noncultured epidermal cell suspension (NCECS) is a commonly used surgical treatment for resistant stable acral vitiligo and vitiligo overlying joints. Platelet-rich plasma (PRP) has been reported to enhance the repigmentation response of different therapeutic modalities for vitiligo, including vitiligo surgery. OBJECTIVE To assess the value of adding of PRP to NCECS in the surgical treatment of acral vitiligo and vitiligo overlying joints. PATIENTS AND METHODS This self-controlled randomised trial included 15 patients with 30 lesions in which NCECS suspended in PRP was performed for one lesion and NCECS in ringer's lactate for another comparable lesion. Following NCECS, patients underwent thrice weekly excimer light sessions for 3 months. After 8 weeks, patients underwent preliminary assessment. By the end of the 3 months, both lesions were compared as regards improvement in surface area and pigmentation. Additionally, physician global assessment was made by a blinded investigator. RESULTS Significant improvement was reported in both lesional extent and pigmentation (after PRP and lactated ringer NCECS) with no statistical difference between them. CONCLUSION Despite previous promising results, suspending NCECS in PRP offered no privilege in surgical treatment of acral vitiligo and vitiligo overlying joints, which are quite resistant to treat. PAN AFRICAN CLINICAL TRIAL REGISTRY ID PACTR202108873035929, Date: 16 August 2021.
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Kim HJ, Son JH, Bang CH, Lee JH, Park Y, Kim YH. Microcutting technique: A novel grafting method for the treatment of vitiligo. Clin Dermatol 2023; 41:545-546. [PMID: 37643697 DOI: 10.1016/j.clindermatol.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
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Ding X, Sun Y, Wang F, Du J. Ultrathin Skin Grafting Versus Suction Blister Epidermal Grafting in the Treatment of Resistant Stable Vitiligo: A Self-Controlled Comparative Study. Dermatol Surg 2023; 49:659-663. [PMID: 37000977 DOI: 10.1097/dss.0000000000003780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
BACKGROUND Surgical therapies are effective methods to treat resistant stable vitiligo, with each method having advantages and disadvantages. OBJECTIVE This study aimed to compare the efficacy and safety of ultrathin skin grafting (UTSG) and suction blister epidermal grafting (SBEG) to treat stable vitiligo. METHODS A total of 15 patients with 45 vitiligo patches were recruited. Each vitiligo patch was divided in half; 1 half was treated by UTSG, whereas the other half was treated by SBEG. The patients were followed up monthly for 3 months to assess the repigmentation rate, relative melanin index (RMI), and relative erythema index (REI) at different timepoints. RESULTS Excellent repigmentation was observed in 97.8% of patches that underwent UTSG and 93.3% that underwent SBEG. The RMI and REI at 1, 2, and 3 months after the grafting procedure did not significantly differ between the 2 methods. At the recipient site, incomplete fall-off of the graft occurred in 4.4% of patches that underwent UTSG, whereas a "cobblestone appearance" was observed in 66.7% of patches that underwent SEBG. UTSG caused fewer complications at the donor site than SBEG. CONCLUSION Compared with SBEG, UTSG is faster and achieves better cosmetic outcomes at the recipient and donor sites.
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Maghfour J, Bardhi R, Huggins R, Hamzavi IH, Mohammad TF. Recipient-to-Donor Ratios in the Surgical Treatment of Vitiligo, Leukoderma, and Piebaldism: A Retrospective Review. Dermatology 2023; 239:828-831. [PMID: 37231873 DOI: 10.1159/000530930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The autologous noncultured melanocyte keratinocyte transplant procedure (MKTP) has emerged as a popular grafting technique with proven efficacy for achieving repigmentation. However, there remains no consensus regarding the optimal recipient-to-donor (RD) ratio required to achieve acceptable repigmentation. In this retrospective cohort study of 120 patients, we sought to examine whether expansion ratios impact the repigmentation success rates following MKTP. RESULTS A total of 69 patients (mean [SD] age was 32.4 [14.3] years, mean follow-up was 30.4 [22.5] months, 63.8% were male; 55% were dark-skinned individuals [Fitzpatrick IV-VI]) were included. The mean percent change in the Vitiligo Area Scoring Index (VASI) was 80.2 (±23.7; RD of 7.3) in patients with focal/segmental vitiligo (SV), 58.3 (±33.0; RD of 8.2) in those with non-segmental vitiligo (NSV), and 51.8 (±33.6; RD of 3.7) in those with leukoderma and piebaldism. Focal/SV was positively associated with a higher percent change in VASI (parameter estimate: 22.6, p value <0.005). In the SV/focal group, non-white patients had a higher RD ratio compared to White individuals (8.2 ± 3.4 vs. 6.0 ± 3.1, respectively, p value = 0.035). DISCUSSION In our study, we found that patients with SV were significantly more likely to achieve higher repigmentation rates compared to those with NSV. Although repigmentation rates were higher in the low expansion ratio group than in the high expansion ratio group, we did not observe a significant difference between the two groups. CONCLUSION MKTP is an effective therapy for restoring repigmentation in patients with stable vitiligo. Therapeutic response of vitiligo to MKTP appears to be influenced by the type of vitiligo, rather than a specific RD ratio.
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Altalhab S, Shalaby SS, Saadi DG, Ezzedine K, AlJasser MI. Risk Factors for Infection After Noncultured Melanocyte Keratinocyte Transplantation for Vitiligo. Dermatol Surg 2022; 48:310-314. [PMID: 35125442 DOI: 10.1097/dss.0000000000003388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Noncultured autologous melanocyte keratinocyte transplantation is considered a safe and effective treatment option in stable vitiligo. Factors associated with risk of infection are still poorly explored. OBJECTIVE To search for factors associated with the risk of infection after noncultured autologous melanocyte keratinocyte transplantation (MKTP). METHOD This was a retrospective multicentric study including all patients with vitiligo who had undergone noncultured autologous MKTP between January 2010 and December 2020. Data included age, sex, site, and size of the treated area, recipient area preparation method, and antibiotic prescription preceding the procedure. Univariate and multivariate analyses to search for factors associated with infection after MKTP were conducted. RESULTS A total of 672 patients were included. Infection was present in 39 of the patients (6%) (95% confidence interval [CI]: 4.2%-7.7%). The following factors were independently associated with higher rate of infection: cryotherapy for recipient area preparation (OR 19.76, 95% CI: 3.21-121.74) and treated lesions on the trunk (OR 2.67, 95% CI: 1.21-5.90), lower extremity (OR 5.99, 95% CI: 2.49-14.40), and foot (OR 13.15, 95% CI: 4.37-39.62). CONCLUSION Infection after noncultured autologous MKTP is not uncommon. Cryotherapy for recipient area preparation and lesions on the trunk, lower extremity, or foot was independently associated with an increased risk of infection.
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Mhatre M, Sharma A, Srihari S, Goldust M. Noncultured Epidermal Suspension in Vitiligo-A Review of Origins, Modifications, and Innovations for this Surgical Masterstroke! Skinmed 2021; 19:419-423. [PMID: 35022112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vitiligo, a disorder of depigmentation, has a profound psychosocial burden. Surgical techniques using transplantation of tissue grafts or melanocytes have long been used to correct vitiliginous macules, often utilizing noncultured epidermal suspension. This procedure has undergone a remarkable transformation from its original methods in terms of preparation of recipient site, concentration and separation of melanocytes, incubation, and cryofreezing.Vitiligo is an acquired hypomelanotic disorder characterized by depigmented and circumscribed macules or patches, with loss of melanin and functional melanocytes from the epidermis. There is a broad range of therapeutic options for vitiligo, including topical agents, ultraviolet therapy, oral therapy, and surgical modalities. Transplanting autologous melanocytes from a normally pigmented donor area to the depigmented skin forms a common principle in all surgical techniques-be it grafting at tissue level or cellular level.1Surgical modalities are further divided into tissue grafts and cellular grafts. Tissue grafting includes thin dermoepidermal grafts, punch grafts with full thickness, suction blister grafts, and epidermal harvesting systems. Cellular grafting employs noncultured epidermal suspensions and cultured melanocyte suspensions.1 The advantages of cellular grafting include large areas of depigmentation that can be treated with ease. In noncultured epidermal cell suspensions (NCES), keratinocytes are not separated from melanocytes, and they help to furnish factors that sustain and promote growth of melanocytes and homogeneity of repigmentation.2 A minimum density of melanocytes required for satisfactory repigmentation is 210-250 per mm.2,3.
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Ahmadaghaei F, Kavoussi H, Ebrahimi A, Rezaei M, Kavoussi R, Salimi E. The effect of simplified autologous melanocyte and keratinocyte grafting on the treatment of refractory vitiligo. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2021; 30:95-98. [PMID: 34565123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Vitiligo is a disease with a high prevalence and burden that has a negative impact on various aspects of life. Because most cases of vitiligo are not responsive to medical treatment, we performed simplified autologous melanocyte and keratinocyte grafting to treat refractory stable vitiligo. METHODS This interventional study was carried out on 32 patients (16 females and 16 males). After local anesthesia at the donor site, we shaved the donor sites to harvest autologous melanocyte material. The harvested paste-like non-trypsinized material was spread over the abraded recipient area. Patient follow-up was performed to track the treatment outcome and possible complications. RESULTS Out of 32 patients with 99 lesions, the generalized type accounted for 28 (87.5%) patients, and 46 (46.5%) lesions were seen in the upper extremity as the most common clinical type and site of involvement. Eighteen (18.2%) and 26 (26.3%) patches showed excellent and good re-pigmentation, respectively, and face areas showed significantly better re-pigmentation (p < 0.001). CONCLUSIONS Simplified autologous melanocyte and keratinocyte grafting is a safe, simple, office-based, and low-cost procedure with a modest re-pigmentation outcome in refractory stable vitiligo. Moreover, the face area had a satisfactory outcome with this procedure.
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Akshi B, Shilpa K, Harish P. A novel point-of-care technique to improve graft uptake in a melanocyte-keratinocyte transplantation procedure for vitiligo of contoured areas such as the external ear. J Am Acad Dermatol 2020; 86:e191-e192. [PMID: 32497701 DOI: 10.1016/j.jaad.2020.05.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022]
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Jain S, Patra S, Choudhary S, Kaur M. An easy way to make blisters in suction blister grafting of vitiligo with Hijama therapy cups. J Am Acad Dermatol 2020; 86:e149-e150. [PMID: 32454099 DOI: 10.1016/j.jaad.2020.04.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022]
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Chiu YJ, Perng CK, Ma H. Fractional CO 2 laser contributes to the treatment of non-segmental vitiligo as an adjunct therapy: a systemic review and meta-analysis. Lasers Med Sci 2018; 33:1549-1556. [PMID: 29696444 DOI: 10.1007/s10103-018-2516-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
The treatment of stable non-segmental vitiligo is often challenging, which new therapies are being searched. Multiple clinical trials have proposed the benefits and safety of using fractional carbon dioxide (CO2) laser as an adjunct therapy to conventional treatments. This study aimed to evaluate the safety and efficacy of fractional carbon dioxide laser as a combination therapy to conventional treatments in patients with stable non-segmental vitiligo. A literature search using PubMed, EMBASE, and the Cochrane Library was performed for comparative studies among vitiligo patients treated with additional fractional CO2 laser. Clinical outcomes in the selected studies were compared, and a meta-analysis was performed via Review Manager version 5.3, according to the PRISMA guidelines. Six studies with a total of 184 patches/patients were included in the present meta-analysis. The combination therapy group had significantly superior results than that of the control group (≥ 75% re-pigmentation, risk ratio [RR] 2.80, 95% confidence interval [CI] 1.29-6.07; ≥ 50% re-pigmentation, RR 2.26, 95% CI 1.23-5.9; < 25% re-pigmentation, RR 0.57, 95% CI 0.43-0.75). Limitations of the study included the small number of studies and sample size, inadequate blinding of participants, and variation between therapy protocols. Meta-analysis revealed that using fractional CO2 laser in combination with conventional treatments is efficient and safe, and may be considered as an adjunct therapeutic option for patients with refractive non-segmental vitiligo.
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Abstract
Use of the 308 nm Excimer laser to treat hypopigmentation and vitiligo is usually superior to conventional ultraviolet (UV) therapy with regard to results and safety. It is particularly advantageous because specific areas of skin can be targeted without burdening the rest of the skin. Fewer sessions with lower cumulative doses are required. Various combination therapies can improve the outcome; selection criteria such as early initiation of treatment and more frequent sessions with shorter intervals make it easier to decide which patients should be treated and how to achieve the greatest benefit.
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Razmi T M, Parsad D, Kumaran SM. Combined epidermal and follicular cell suspension as a novel surgical approach for acral vitiligo. J Am Acad Dermatol 2017; 76:564-567. [PMID: 28212764 DOI: 10.1016/j.jaad.2016.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/19/2022]
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