Treatment of Vitiligo With a Melanocyte-Keratinocyte Cell Suspension Versus Dermabrasion Only: A Pilot Study With a 12-Month Follow Up
September 2011 | Volume 10 | Issue 9 | Original Article | 1032 | Copyright © 2011
Background: Dermabrasion is a surgical procedure that has been used for repigmentation; however, autologous transplantation of uncultured melanocytes in a suspension combined with the use of adjunct treatment provides better results.
Purpose: To evaluate the clinical effectiveness of dermoabrasion (DA) and melanocyte-keratinocyte cell suspension transplantation (DA+MKT) vs. dermabrasion with no adjunct treatment.
Materials and Methods: We selected 11 patients (six women and five men) with stable vitiligo. From these, two achromic maculae of similar size were selected. One macule was treated with DA+MKT and the other with DA only. The main parameter of treatment efficacy was the percentage of repigmentation in the area treated, three and 12 months after implantation.
Results: In seven of the 11 patients, slightly better pigmentation occurred with DA+MKT. Two of these patients had a repigmentation greater than 50 percent and in two other patients, the result was similar for both techniques, although slightly better with MKT. Two more patients showed less than 20 percent repigmentation, but only in the area treated with DA+MKT. One patient showed pigmentation initially after DA+MKT only, and subsequent depigmentation.
Conclusion: DA+MKT produced slightly better repigmentation than DA only when given without adjunct treatment in a 12-month follow-up period.
J Drugs Dermatol. 2011;10(9):1032-1036.
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Vitiligo is an acquired hypomelanosis of the skin with an incidence of 0.5 percent to two percent world-wide, and is more apparent in people of color and in certain Fitzpatrick skin types.1 Vitiligo is characterized by well-circumscribed achromic or hypochromic maculae or patches without melanocytes, or, if melanocytes are present, they are nonfunctional.2 Although some melanocytes can be identified by immunohistochemistry in vitiligo maculae, hypofunctioning melanocytes are observed.1 Tobin et al. reported in 2000 that vitiligo maculae always have melanocytes.3
Repigmentation of achromic areas can be achieved with the application of topical glucocorticoids or oral or topical psoralens and subsequent exposure to ultraviolet light (320-400 nm); however, fewer than 20 percent of patients show total repigmentation.4,5
A number of surgical techniques have shown varying degrees of success in the treatment of vitiligo and others have simply failed. There is currently no technique that can achieve complete eradication of vitiligo. Surgical techniques are used mainly for stable vitiligo, which is present in about five percent of patients. Vitiligo is defined as stable when maculae or patches have not increased in size and no new maculae have appeared for a period of one year.6.7
Repigmentation can sometimes be induced with dermabrasion (DA).8 Mechanical stimulation increases cytokine release, which stimulates melanocytes to produce melanin. Sethi et al. performed a self-controlled study in which they evaluated DA alone, DA+5-fluorouracil (DA+5-FU), and DA+Placentrex® gel (DA+Placentrex). They achieved more repigmentation with DA+5-FU than DA alone and DA+Placentrex produced similar results.9