Four compartment method: a simplified and cost-effective method of noncultured epidermal cell suspension for the treatment of vitiligo

Lesional CD8+ T-Cell Number Predicts Surgical Outcomes of Melanocyte-Keratinocyte Transplantation Surgery for Vitiligo

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.

Autologous Non-Cultured Epidermal Cellular Grafting in the Surgical Treatment of Stable Vitiligo: The Skin Hospital Protocol

Autologous non-cultured epidermal cellular grafting is the treatment of choice for patients with stable refractory vitiligo. Recently, studies have shown cost-effective alternatives for this procedure, superseding previous techniques that required large research facilities or expensive pre-packaged kits. We provide modifications to current techniques, including the use of individual Petri dishes to allow for processing larger skin grafts, hyfrecation instead of conventional manual dermabrasion of the recipient site to reduce scar formation as well as better margin delineation, and an intravenous giving set with a filter for improved filtration of the mixed cell population. These modifications facilitated sufficient skin repigmentation in a cost-effective outpatient setting.

Comparative Evaluation of Efficacy of Non-cultured Epidermal Cell Suspension and Epidermal Curettage in Stable Vitiligo

CONTEXT

Vitiligo is a common primary acquired pigmentary disorder due to loss of epidermal functioning melanocytes. Many surgical techniques have evolved over the years for its treatment and the need of a cost-effective modality has always been put forward.

AIM

The aim of the study was to compare the efficacy of non-cultured epidermal cell suspension with that of epidermal curettage in repigmentation of stable vitiligo.

SETTINGS AND DESIGN

It was a prospective randomized non-controlled study.

SUBJECTS AND METHODS

Forty lesions were selected in patients of stable, recalcitrant vitiligo belonging to different age-groups and genders. After histopathological confirmation, the patients were taken up for surgery after obtaining written consent and were divided into two groups for two different procedures, that is, non-cultured epidermal cell suspension (Group A) and epidermal curettage (Group B). Follow-up was carried out at 2, 4, 8, and 12 weeks of procedure to assess the repigmentation achieved.

STATISTICAL ANALYSIS

Statistical Package for Social Sciences (SPSS) software, version 21.0, was used.

RESULTS

At the end of the study, >50% repigmentation was achieved in 95% (19 of 20) lesions of Group A and 85% (17 of 20) lesions in Group B, whereas >75% repigmentation was achieved in 60% (12 of 20) in both Groups A and B. The color matching with surrounding skin and yield of graft was better in epidermal cell suspension technique than that in epidermal curettage. The difference was not statistically significant.

CONCLUSION

Though both the surgical techniques of melanocyte transplantation are effective in achieving uniform pigmentation, epidermal curettage has an extra edge of being simpler and more cost-effective.

Vitiligo surgery: A journey from tissues via cells to the stems!

Depigmented patches in vitiligo, a common dermatosis, cause a great psychological distress to the patients. Hence, apart from halting the disease process, the strategies to impart normal skin colour to these white patches carry an important role in the management of vitiligo. Surgical procedures are often required for stable vitiligo lesions not responding to medical therapies. It involves "shuffling" of melanocytes from the pigmented skin to the depigmented areas. During the last fifty years, the vitiligo surgery has evolved from tissue transplantation via cellular transplantation to reach a stage where the use of stem cells or immunomodulatory cells is contemplating. We would like to depict this wonderful journey of vitiligo surgery through this viewpoint.

Autologous non-cultured melanocyte-keratinocyte transplantation in the treatment of vitiligo: patient selection and perspectives

Autologous non-cultured melanocyte–keratinocyte transplantation procedure (MKTP) is one of the simplest cellular grafting techniques. Various modifications were done over the years to make the technique easier and more economical which led to its great popularity among dermatologists. Proper patient selection and good technical skills are essential for achieving success with this technique. In this review, different patient-related and procedure-related factors that affect the outcome are discussed. This review may guide dermatologists to select suitable candidates, and explains what to expect in each case and indicates different techniques which can be used. The expected complications and stability of acquired pigmentation, which are an essential part of the pretreatment patient counseling, are also discussed.

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.