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Elmorsy EH, El Garem YF, Affara SM, Halwag DI. Noncultured Trypsinized Epidermal Cell Suspension Transplantation After Cryoblebbling Versus Noncultured Nontrypsinized Epidermal Cell Graft Homogenized With Plasma Gel After Dermabrasion for Stable Vitiligo. Dermatol Surg 2024:00042728-990000000-00800. [PMID: 38742750 DOI: 10.1097/dss.0000000000004231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Vitiligo treatment is challenging, especially for resistant and stable vitiligo, which requires surgical management. Noncultured epidermal cell suspension has been modified to enhance the treatment outcomes. OBJECTIVE Comparison of autologous noncultured trypsinized epidermal cell suspension in recipient site prepared by cryoblebbling and noncultured nontrypsinized epidermal cell graft homogenized with plasma gel in recipient site prepared by dermabrasion for stable vitiligo treatment. MATERIALS AND METHODS Interventional comparative study on 30 patients with stable vitiligo, randomly divided into 2 equal groups. Group A: noncultured trypsinized epidermal cell suspension for recipient prepared by cryoblebbling. Group B: noncultured nontrypsinized epidermal cell graft homogenized with plasma gel for recipient prepared by dermabrasion. Afterward, both groups received 3 months of narrow-band ultraviolet B phototherapy. RESULTS The plasma gel group showed a significantly earlier onset of repigmentation and faster healing (p = .002* and <.001*, respectively). Overall, repigmentation was higher in the plasma gel group (p = .037* at the end of the second month). Color matching and patient satisfaction were higher in the plasma gel group, without statistical significance. The cryobleb group showed more recipient site complications, and the plasma gel procedure was relatively easier and cheaper. CONCLUSION Plasma gel modification is cost-effective, less time-consuming, does not require trypsinization, and provides rapid, satisfactory, and uniform repigmentation. Cryoblebbing and trypsinization are effective; however, there are more technical difficulties, delayed healing, and delayed onset of repigmentation.
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Affiliation(s)
- Eman Hamed Elmorsy
- All authors are affiliated with the Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Jin R, Hong W, Ye Z, Fu L, Hu W, Xu A. Comparative outcomes of autologous cultured melanocytes transplantation and non-cultured epidermal cell suspension transplantation in piebaldism patients: A retrospective study. Skin Res Technol 2024; 30:e13580. [PMID: 38225879 PMCID: PMC10790057 DOI: 10.1111/srt.13580] [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: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE To compare the efficacy and safety of autologous cultured melanocytes transplantation (CMT) and non-cultured epidermal cell suspension transplantation (NCES) in the treatment of piebaldism. PATIENTS AND METHODS A retrospective study was conducted on 30 anatomically based lesions from nine piebaldism patients who underwent either CMT (n = 7) or NCES (n = 23) between 2018 and 2020. The extent of repigmentation and colour matching was evaluated in all recipient sites using a digital imaging analysis system. In addition, adverse effects have also been assessed by follow-up results. RESULTS More than 75% repigmentation was achieved in 100% (7/7) and 60.9% (14/23) of the 30 lesions with the CMT and NCES, respectively. There were significant differences between the two methods in terms of repigmentation. The majority of patients had colour mismatches, and there was no discernible difference between the two surgical techniques. Adverse reactions rarely occurred. CONCLUSION The present study suggested that autologous CMT may provide better repigmentation in piebaldism patients than NCES with no significant side effects.
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Affiliation(s)
- Rong Jin
- Department of DermatologyHangzhou Third People's HospitalHangzhouPR China
| | - Weisong Hong
- Department of DermatologyHangzhou Third People's HospitalHangzhouPR China
| | - Zhubiao Ye
- Department of DermatologyHangzhou Third People's HospitalHangzhouPR China
| | - Lifang Fu
- Department of DermatologyHangzhou Third People's HospitalHangzhouPR China
| | - Wenting Hu
- Department of DermatologyHangzhou Third People's HospitalHangzhouPR China
| | - Aie Xu
- Department of DermatologyHangzhou Third People's HospitalHangzhouPR China
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3
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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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Affiliation(s)
- Maggi A Refat
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA; Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - James P Strassner
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Michael L Frisoli
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Mehdi Rashighi
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Jillian Richmond
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Essam Nada
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohammed Abu El-Hamd
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Dori Goldberg
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Bassel H Mahmoud
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - John E Harris
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA.
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Shahbazi A, Abedi Valugerdi M, Kazemi S, Samadi Kochaksaraei S, Naseh MH, Aghdami N, Sadeghi B. Safety and Efficacy of Autologous Melanocyte/Keratinocyte Transplantation in Patients with Refractory Stable Vitiligo. Dermatology 2023; 239:919-925. [PMID: 37573775 DOI: 10.1159/000533353] [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: 09/09/2022] [Accepted: 07/30/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Vitiligo is a common depigmentation skin disease associated with significant psychosocial morbidity and profound effect on the quality of life. The treatment of vitiligo is still a major challenge in the field of dermatology. Currently, topical steroids, calcineurin inhibitors, ultraviolet phototherapy, surgery, and cultured and non-cultured epidermal melanocyte transplantation are used for the treatment of vitiligo. However, the effectiveness of these treatment modalities is limited by the lack of response, long-term treatment periods, high cost, and inevitable adverse effects. OBJECTIVES In this study, we aimed to evaluate the efficacy of intraepidermal injection of autologous non-cultured melanocytes and keratinocytes as an alternative therapy for the refractory and stable (RS) vitiligo. METHODS The treatment procedure was performed on thirty-nine RS vitiligo patients. The autologous skin grafts obtained from the buttock area and epidermis were separated from dermis using dispase. Single-cell autologous melanocytes and keratinocytes were prepared from the epidermis by trypsin/ethylene diamine tetra acetic acid and injected at the concentration of 100-400 × 103 cells/cm2, intra-epidermally to the selected vitiligo lesions. Vitiligo re-pigmentation was monitored employing photography. Photographs were taken prior to and 2, 4, and 6 months after the cell transplantation. Improvement of the skin depigmentation was classified as follows: <25% as minimal response, 26-50% as moderate response, 51-75% as good response, and finally 76-100% as excellent response. RESULTS Cell infusion appeared to be safe as none of the patients exhibited any adverse effects. At the end of the sixth month follow-up period, of the treated patients, 12.8% demonstrated an excellent response, 36% exhibited a good response, and 51.2% showed a moderate to minimal response to the administered therapy. Obtained significant p value for Wilcoxon test over the checkpoints at 2nd, 4th, and 6th month (p = 0.03, 0.04, and 0.039, respectively) post-cell transplantation confirmed notable growing trend in the re-pigmentation. CONCLUSION Our findings provide a strong support for the therapeutic efficacy of autologous non-cultured melanocytes and keratinocytes in patients with RS vitiligo.
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Affiliation(s)
- Atefeh Shahbazi
- Department of Cellular and Molecular Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Manuchehr Abedi Valugerdi
- Department of Laboratory Medicine, Biomolecular Medicine, Translational Research Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Sepide Kazemi
- Department of Clinical Science, Translational Cell therapy Research (TCR), Intervention and Technology, CLINTEC, Karolinska Institutet, Huddinge, Sweden
| | - Sarvenaz Samadi Kochaksaraei
- Department of Clinical Science, Translational Cell therapy Research (TCR), Intervention and Technology, CLINTEC, Karolinska Institutet, Huddinge, Sweden
| | - Mohammad Hassan Naseh
- Hair and skin clinic, Red Crescent Poly Clinic, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Nasser Aghdami
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Department of Infectious Diseases and Tropical Medicines, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Sadeghi
- Department of Clinical Science, Translational Cell therapy Research (TCR), Intervention and Technology, CLINTEC, Karolinska Institutet, Huddinge, Sweden
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Dermabrasion Versus Microneedling in Transplantation of Autologous Noncultured Melanocyte-Keratinocyte Cell Suspension in Patients With Vitiligo. Dermatol Surg 2023; 49:494-502. [PMID: 36892550 DOI: 10.1097/dss.0000000000003738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
BACKGROUND Autologous noncultured melanocyte-keratinocyte transplantation is one of the procedures used to treat stable vitiligo with varying reported results. Recipient site preparation is one of the variables that could affect repigmentation outcomes. OBJECTIVE To assess the effectiveness of transplanting autologous melanocyte-keratinocyte suspension in patients with stable vitiligo and to compare recipient site preparation using dermabrasion versus microneedling. METHODS From March 2020 to September 2022, this randomized comparative study included 40 patients with 40 stable vitiligo lesions managed by suspension transplants of melanocytes. Patients were divided into 2 groups: group A, where the recipient site was prepared using dermabrasion, and group B, which was done by microneedling. The assessment was performed 3 months after the treatment based on the degree of repigmentation (excellent, ≥90%; good, 50%-89%; fair, 20%-49%; and poor response, <20%). RESULTS Both modalities resulted in effective repigmentation, but the dermabrasion group showed a statistically significant improvement and a satisfactory repigmentation rate. CONCLUSION Autologous melanocyte transplantation is a safe and effective treatment method for stable vitiligo lesions that have not responded to other therapies. When compared with microneedling, dermabrasion produced better outcomes for recipient site preparation.
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Domaszewska-Szostek A, Polak A, Słupecka-Ziemilska M, Krzyżanowska M, Puzianowska-Kuźnicka M. Current Status of Cell-Based Therapies for Vitiligo. Int J Mol Sci 2023; 24:ijms24043357. [PMID: 36834766 PMCID: PMC9964504 DOI: 10.3390/ijms24043357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Vitiligo is a chronic pigmentary disease with complex etiology, the signs of which are caused by the destruction of melanocytes in the epidermis, leading to the lack of melanin pigment responsible for skin coloration. The treatment of vitiligo, which aims at repigmentation, depends both on the clinical characteristics of the disease as well as on molecular markers that may predict the response to treatment. The aim of this review is to provide an overview of the clinical evidence for vitiligo cell-based therapies taking into account the required procedures and equipment necessary to carry them out as well as their effectiveness in repigmentation, assessed using the percentage of repigmentation of the treated area. This review was conducted by assessing 55 primary clinical studies published in PubMed and ClinicalTrails.gov between 2000 and 2022. This review concludes that the extent of repigmentation, regardless of the treatment method, is highest in stable localized vitiligo patients. Moreover, therapies that combine more than one cell type, such as melanocytes and keratinocytes, or more than one method of treatment, such as the addition of NV-UVB to another treatment, increase the chances of >90% repigmentation. Lastly, this review concludes that various body parts respond differently to all treatments.
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Affiliation(s)
- Anna Domaszewska-Szostek
- Department of Human Epigenetics, Mossakowski Medical Research Institute, PAS, 02-106 Warsaw, Poland
| | - Agnieszka Polak
- Faculty of Biology, University of Cambridge, Cambridge CD2 1TN, UK
| | - Monika Słupecka-Ziemilska
- Department of Human Epigenetics, Mossakowski Medical Research Institute, PAS, 02-106 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-60-86-401
| | - Marta Krzyżanowska
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University in Toruń, 85-168 Bydgoszcz, Poland
| | - Monika Puzianowska-Kuźnicka
- Department of Human Epigenetics, Mossakowski Medical Research Institute, PAS, 02-106 Warsaw, Poland
- Department of Geriatrics and Gerontology, Medical Centre of Postgraduate Education, 01-813 Warsaw, Poland
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Ju HJ, Bae JM, Lee RW, Kim SH, Parsad D, Pourang A, Hamzavi I, Shourick J, Ezzedine K. Surgical Interventions for Patients With Vitiligo: A Systematic Review and Meta-analysis. JAMA Dermatol 2021; 157:307-316. [PMID: 33595599 DOI: 10.1001/jamadermatol.2020.5756] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgical interventions are a key part of the therapeutic arsenal, especially in refractory and stable vitiligo. Comparison of treatment outcomes between the different surgical procedures and their respective adverse effects has not been adequately studied. Objective To investigate the reported treatment response following different surgical modalities in patients with vitiligo. Data Sources A comprehensive search of the MEDLINE, Embase, Web of Science, and Cochrane Library databases from the date of database inception to April 18, 2020, was conducted. The key search terms used were vitiligo, surgery, autologous, transplantation, punch, suction blister, and graft. Study Selection Of 1365 studies initially identified, the full texts of 358 articles were assessed for eligibility. A total of 117 studies were identified in which punch grafting (n = 19), thin skin grafting (n = 10), suction blister grafting (n = 29), noncultured epidermal cell suspension (n = 45), follicular cell suspension (n = 9), and cultured epidermal cell suspension (n = 17) were used. Data Extraction and Synthesis Three reviewers independently extracted data on study design, patients, intervention characteristics, and outcomes. Random effects meta-analyses using generic inverse-variance weighting were performed. Main Outcomes and Measures The primary outcomes were the rates of greater than 90%, 75%, and 50% repigmentation response. These rates were calculated by dividing the number of participants in an individual study who showed the corresponding repigmentation by the total number of participants who completed the study. The secondary outcomes were the factors associated with treatment response to the surgical intervention. Results Among the 117 unique studies and 8776 unique patients included in the analysis, rate of repigmentation of greater than 90% for surgical interventions was 52.69% (95% CI, 46.87%-58.50%) and 45.76% (95% CI, 30.67%-60.85%) for punch grafting, 72.08% (95% CI, 54.26%-89.89%) for thin skin grafting, 61.68% (95% CI, 47.44%-75.92%) for suction blister grafting, 47.51% (95% CI, 37.00%-58.03%) for noncultured epidermal cell suspension, 36.24% (95% CI, 18.92%-53.57%) for noncultured follicular cell suspension, and 56.82% (95% CI, 48.93%-64.71%) for cultured epidermal cell suspension. The rate of repigmentation of greater than 50% after any surgical intervention was 81.01% (95% CI, 78.18%-83.84%). In meta-regression analyses, the treatment response was associated with patient age (estimated slope, -1.1418), subtype of vitiligo (estimated slope, 0.3047), and anatomical sites (estimated slope, -0.4050). Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that surgical intervention can be an effective option for refractory stable vitiligo. An appropriate procedure should be recommended based on patient age, site and size of the lesion, and costs.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Jung Min Bae
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Ro Woo Lee
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Soo Hyung Kim
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigharh, India
| | - Aunna Pourang
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Iltefat Hamzavi
- Vitiligo Unit, Multicultural Dermatology Center, Henry Ford Hospital, Detroit, Michigan
| | - Jason Shourick
- Epidemiology in Dermatology and Evaluation of Therapeutics, Département Infectieux/Immuno/Vaccin, Paris-Est University, Paris Est Créteil University, Créteil, France.,Department of Dermatology, Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris Est Créteil University, Créteil, France
| | - Khaled Ezzedine
- Epidemiology in Dermatology and Evaluation of Therapeutics, Département Infectieux/Immuno/Vaccin, Paris-Est University, Paris Est Créteil University, Créteil, France.,Department of Dermatology, Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris Est Créteil University, Créteil, France
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Narayan VS, van den Bol LLC, van Geel N, Bekkenk MW, Luiten RM, Wolkerstorfer A. Donor to recipient ratios in the surgical treatment of vitiligo and piebaldism: a systematic review. J Eur Acad Dermatol Venereol 2021; 35:1077-1086. [PMID: 33428279 PMCID: PMC8247963 DOI: 10.1111/jdv.17108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022]
Abstract
Stabilized vitiligo resistant to conventional therapy (e.g. segmental vitiligo) and piebaldism lesions can be treated with autologous cellular grafting techniques, such as non-cultured cell suspension transplantation (NCST) and cultured melanocyte transplantation (CMT). These methods are preferred when treating larger surface areas due to the small amount of donor skin needed. However, the donor to recipient expansion ratios and outcomes reported in studies with cellular grafting vary widely, and to date, no overview or guideline exists on the optimal ratio. The aim of our study was to obtain an overview of the various expansion ratios used in cellular grafting and to identify whether expansion ratios affect repigmentation and colour match. We performed a systematic literature search in MEDLINE and EMBASE to review clinical studies that reported the expansion ratio and repigmentation after cellular grafting. We included 31 eligible clinical studies with 1591 patients in total. Our study provides an overview of various expansion ratios used in cellular grafting for vitiligo and piebaldism, which varied from 1:1 up to 1:100. We found expansion ratios between 1:1 and 1:10 for studies investigating NCST and from 1:20 to 1:100 in studies evaluating CMT. Pooled analyses of studies with the same expansion ratio and repigmentation thresholds showed that when using the lowest (1:3) expansion ratio, the proportion of lesions achieving >50% or >75% repigmentation after NCST was significantly better than when using the highest (1:10) expansion ratio (χ2 P = 0.000 and χ2 P = 0.006, respectively). Less than half of our included studies stated the colour match between different expansion ratios, and results were variable. In conclusion, the results of our study indicate that higher expansion ratios lead to lower repigmentation percentages after NCST treatment. This should be taken into consideration while determining which expansion ratio to use for treating a patient.
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Affiliation(s)
- V S Narayan
- Department of Dermatology, Amsterdam University Medical Center, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | - L L C van den Bol
- Department of Dermatology, Amsterdam University Medical Center, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | - N van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - M W Bekkenk
- Department of Dermatology, Amsterdam University Medical Center, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | - R M Luiten
- Department of Dermatology, Amsterdam University Medical Center, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Center, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
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Zhang D, Wei X, Hong W, Fu L, Qian G, Xu AE. A retrospective study of long term follow-up of 2283 vitiligo patients treated by autologous, non-cultured melanocyte-keratinocyte transplantation. Aging (Albany NY) 2021; 13:5415-5425. [PMID: 33582653 PMCID: PMC7950304 DOI: 10.18632/aging.202472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Dimin Zhang
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Xiaodong Wei
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Weisong Hong
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Lifang Fu
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Guopei Qian
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Ai-E Xu
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
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11
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Elgarhy LH, Nofal OE, El-Shorbagy SH, Abdel-Latif AM. Autologous noncultured, nontrypsinized melanocyte-keratinocyte graft homogenized in plasma gel followed by narrow-band ultraviolet B therapy for stable vitiligo: A novel technique. Dermatol Ther 2020; 33:e14362. [PMID: 33006221 DOI: 10.1111/dth.14362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/12/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
There is a continuous need for modifications of epidermal cell grafting techniques treating stable vitiligo to make it easier, more economic, and with better outcome. To evaluate the efficacy and safety of noncultured, nontrypsinized epidermal cell graft homogenized with plasma gel, followed by narrow band-ultraviolet B (NB-UVB) in treatment of stable vitiligo, about 40 patients with stable vitiligo underwent harvesting of epidermal cells from the donor site by dermabrasion then the harvested cells were prepared, homogenized with autologous plasma gel, and applied to the abraded recipient, followed by 16 NB-UVB sessions after complete healing. Patches within the same anatomical site received only NB-UVB as controls. The percentage of improvement ranged from 23.33% to 100% with more than 75% uniform, homogenous repigmentation in 65% of patients. Donor site healed completely with normal skin. Noncultured, nontrypsinized epidermal cell grafting technique homogenized with plasma gel followed by NB-UVB sessions gave positive responses and was well tolerated in different body sites in stable resistant vitiligo.
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Affiliation(s)
- Lamia Hamouda Elgarhy
- Department of Dermatology and Venereology, Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Department of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ola Elgharably Nofal
- Department of Dermatology and Venereology, Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Department of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Safinaz Hamdi El-Shorbagy
- Department of Dermatology and Venereology, Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Department of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amany Mohamed Abdel-Latif
- Department of Dermatology and Venereology, Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Department of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Thakur V, Kumar S, Kumaran MS, Kaushik H, Srivastava N, Parsad D. Efficacy of Transplantation of Combination of Noncultured Dermal and Epidermal Cell Suspension vs Epidermal Cell Suspension Alone in Vitiligo: A Randomized Clinical Trial. JAMA Dermatol 2019; 155:204-210. [PMID: 30601885 DOI: 10.1001/jamadermatol.2018.4919] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgical interventions, notably noncultured epidermal suspension (NCES), are the next line of treatment in patients with vitiligo who fail to respond to medical therapy. Noncultured epidermal suspension is usually performed in patients with vitiligo with duration of clinical stability (DS) of 12 months or longer because DS is a vital parameter in determining outcome of NCES. In this pilot study, we planned to assess the efficacy of a novel combination of noncultured epidermal cell suspension and noncultured dermal cell suspension (NCES and NDCS) in patients with vitiligo with shorter DS (3-6 months). Objective To compare the efficacy of transplantation of NCES and NDCS vs NCES alone in patients with vitiligo with DS of 3 to 6 months. Design, Setting, and Participants A single-center randomized clinical trial including 40 patients with focal, segmental, or generalized vitiligo with DS of 3 to 6 months or more than 12 months was carried out. Based on DS, 2 groups including 20 patients each were recruited (DS in group 1, 3 to 6 months; DS in group 2, more than 12 months). Each group was further randomized into 2 subgroups, A and B. Intervention Patients in subgroups 1A and 2A underwent NCES alone, whereas patients in subgroups 1B and 2B underwent NCES and NDCS. Main Outcomes and Measures Extent of repigmentation, color match, and pattern of repigmentation at 24 weeks. Results Of the 40 study participants, mean (SD) age was 24.9 (4.0) years and 24 (60%) were women; in group 1 with DS for 3 to 6 months, more than 75% repigmentation at 24 weeks was observed in all 10 patients in subgroup 1B (NCES and NDCS) compared with 3 of 10 patients in subgroup 1A (NCES) (100% vs 30%, P = .003). In group 2 (DS > 12 months), the same was observed in 6 of 10 patients in subgroup 2A and 7 of 10 patients in subgroup 2B (NCES) (60% vs 70%, P > .99). The 2 groups and subgroups did not show any significant differences with respect to color matching and pattern of repigmentation. Conclusions and Relevance Combination of NCES and NDCS resulted in excellent response in patients with vitiligo with shorter duration of clinical stability compared with NCES alone. This combination may be used early in the course of stable vitiligo without waiting for a period of 12 months or more since last clinical activity. Trial Registration ClinicalTrials.gov identifier: NCT03013049.
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Affiliation(s)
- Vishal Thakur
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheetanshu Kumar
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Kaushik
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niharika Srivastava
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bassiouny D, Esmat S. Autologous non-cultured melanocyte-keratinocyte transplantation in the treatment of vitiligo: patient selection and perspectives. Clin Cosmet Investig Dermatol 2018; 11:521-540. [PMID: 30464567 PMCID: PMC6208871 DOI: 10.2147/ccid.s151503] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Dalia Bassiouny
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt,
| | - Samia Esmat
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt,
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Ramos MG, Ramos DG, Ramos CG. Evaluation of treatment response to autologous transplantation of noncultured melanocyte/keratinocyte cell suspension in patients with stable vitiligo. An Bras Dermatol 2018; 92:312-318. [PMID: 29186240 PMCID: PMC5514568 DOI: 10.1590/abd1806-4841.20175700] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/16/2016] [Indexed: 01/22/2023] Open
Abstract
Background Vitiligo is a chronic disease characterized by the appearance of achromic
macules caused by melanocyte destruction. Surgical treatments with
melanocyte transplantation can be used for stable vitiligo cases. Objectives To evaluate treatment response to the autologous transplantation of
noncultured epidermal cell suspension in patients with stable vitiligo. Methods Case series study in patients with stable vitiligo submitted to noncultured
epidermal cell suspension transplantation and evaluated at least once,
between 3 and 6 months after the procedure, to observe repigmentation and
possible adverse effects. The maximum follow-up period for some patients was
24 months. Results Of the 20 patients who underwent 24 procedures, 25% showed an excellent rate
of repigmentation, 50% good repigmentation, 15% regular, and 10% poor
response. The best results were observed in face and neck lesions, while the
worst in extremity lesions (88% and 33% of satisfactory responses,
respectively). Patients with segmental vitiligo had a better response (84%)
compared to non-segmental ones (63%). As side effects were observed
hyperpigmentation of the treated area and the appearance of Koebner
phenomenon in the donor area. Study limitations Some limitations of the study included the small number of patients, a
subjective evaluation, and the lack of long-term follow-up on the results.
CONCLUSION: Noncultured epidermal cell suspension transplantation is
efficient and well tolerated for stable vitiligo treatment, especially for
segmental vitiligo on the face and neck.
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Affiliation(s)
- Mariana Gontijo Ramos
- College of Human, Social, and Health Sciences, Universidade Fumec - Belo Horizonte (MG), Brazil.,Private clinic - Belo Horizonte (MG), Brazil
| | - Daniel Gontijo Ramos
- Dermatology Clinic, Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil.,Private clinic - Belo Horizonte (MG), Brazil
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Vakharia PP, Lee DE, Khachemoune A. Efficacy and safety of noncultured melanocyte-keratinocyte transplant procedure for vitiligo and other leukodermas: a critical analysis of the evidence. Int J Dermatol 2018; 57:770-775. [PMID: 29318598 DOI: 10.1111/ijd.13895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/31/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Paras P Vakharia
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Dylan E Lee
- Creighton University School of Medicine, Omaha, NE, USA
| | - Amor Khachemoune
- Dermatology Service, Veterans Affairs Hospital & SUNY Downstate Medical Center, Brooklyn, NY, USA
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16
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Modified Technique of Cultured Epithelial Cells Transplantation on Facial Segmental Vitiligo. J Craniofac Surg 2017; 28:1462-1467. [DOI: 10.1097/scs.0000000000003834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Wu XG, Xu AE. Successful Treatment of Vitiligo on the Scalp of a 9-Year-Old Girl Using Autologous Cultured Pure Melanocyte Transplantation. Pediatr Dermatol 2017; 34:e22-e23. [PMID: 27813161 DOI: 10.1111/pde.13016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leukotrichia frequently accompanies vitiligo on hairy areas such as the scalp. Treatment with conventional medical therapy is usually unsuccessful because of deficiencies in the melanocyte reservoir. We describe transplantation of autologous cultured pure melanocytes for scalp vitiligo with leukotrichia in a 9-year-old girl, resulting in almost complete and stable repigmentation of skin and hair.
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Affiliation(s)
- Xin-Gang Wu
- Department of Dermatology, Third People's Hospital of Hangzhou, Hangzhou, China.,Institute of Dermatology and Venereology, Hangzhou, China
| | - Ai-E Xu
- Department of Dermatology, Third People's Hospital of Hangzhou, Hangzhou, China.,Institute of Dermatology and Venereology, Hangzhou, China
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18
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Goren A, Bolanča Ž, Lotti T, Šitum M. Novel technique for repigmentation of senescence grey hair. Dermatol Ther 2016; 30. [PMID: 27917579 DOI: 10.1111/dth.12436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/18/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Željana Bolanča
- Department of Dermatovenereology, University Hospital Center "Sestre Milosrdnice"
| | | | - Mirna Šitum
- Department of Dermatovenereology, University Hospital Center "Sestre Milosrdnice"
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19
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Janowska A, Dini V, Panduri S, Macchia M, Oranges T, Romanelli M. Epidermal skin grafting in vitiligo: a pilot study. Int Wound J 2016; 13 Suppl 3:47-51. [PMID: 27547963 DOI: 10.1111/iwj.12632] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022] Open
Abstract
Vitiligo is a multifactorial acquired dermatosis characterised by achromic or hypochromic macules and by the absence of functioning melanocytes. Treatment depends on the extent of the affected areas and on disease activity. Surgical techniques have proven to be effective in stable cases but can be time-consuming and, in some cases, aesthetically unsatisfying or painful for the patients. The aim of the study was to assess the clinical safety and effectiveness of a new automatic epidermal skin harvesting device in patients with stable localised vitiligo over a minimum 12-month period. This new system (CELLUTOME™ Epidermal Harvesting System, KCI, an ACELITY Company, San Antonio, TX) is a commercially available epidermal skin harvesting system that can be used without local anaesthesia or other pre-treatments and has been shown to have low rates of donor site morbidity. Epidermal skin grafts can used in patients with acute and hard to heal chronic wounds, burns and stable vitiligo. The use of advanced therapies may improve the quality of life, have cost benefits and accelerate re-pigmentation of patients with vitiligo. In our preliminary study, this system was seen to be a safe and efficacious means of harvesting epidermal micrografts containing melanocytes for use in patients with stable vitiligo unresponsive to standard therapies.
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Affiliation(s)
- Agata Janowska
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
| | - Valentina Dini
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
| | - Salvatore Panduri
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
| | - Michela Macchia
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
| | - Marco Romanelli
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
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