Melanocytes Transplantation in Patients With Vitiligo Using Needling Micrografting Technique

May 2013 | Volume 12 | Issue 5 | Original Article | 74 | Copyright © May 2013


Khalifa E. Sharquie MD PhD,a Adil A. Noaimi MD DDV FICMS,b and Hana A. Al-Mudaris MDc

aScientific Council of Dermatology and Venereology, Iraqi Board for Medical Specializations, Baghdad, Iraq
bDepartment of Dermatology and Venereology, College of Medicine, University of Baghdad, Baghdad, Iraq
cDepartment of Dermatology and Venereology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq

Abstract
BACKGROUND: Some cases of vitiligo require melanocyte transplantation, but these surgical techniques have varying degrees of success.
OBJECTIVES: To perform melanocytes transplantion in patients with vitiligo using a new needling micrografting technique.
PATIENTS and METHODS: This interventional case study took place at the Department of Dermatology and Venereology at Baghdad Teaching Hospital from December 2010 to September 2011. Twelve patients with vitiligo were included. A split-thickness skin graft was taken from the normal area and cut into micropieces ranging from 0.1 mm to 0.3 mm in diameter. The recipient area was anesthetized, and the micrografts were then implanted into the dermis using the needling technique. The number of implanted micrografts depended on the size of the recipient area. Follow-up was conducted every 2 weeks for the first month and then every 4 weeks for a further 16 weeks.
RESULTS: The intake rate of grafting at week 2 ranged from 90% to 100%. The micrografts started producing noticeable pigmentation at week 2, and pigmentation was obvious at week 4. At week 8, the rate of pigmentation ranged from 10% to 90% (25.24%), and at week 16 it ranged from 10% to 100% (61.36%).
CONCLUSION: This new approach to the treatment of vitiligo delivers rapid and satisfactory pigmentation.

J Drugs Dermatol. 2013;12(5):e74-e78.

INTRODUCTION

Vitiligo is a common autoimmune inflammatory disease where there is an absence, deficiency, or dysfunction of melanocytes.1-4 There are many standard therapies for vitiligo, such as psoralen combined with ultraviolet A (PUVA), PUVA Sole5,6 steroids, UVB Narrowband,7 5% tincture iodine solution, 8,9 and lactic acid.10 Response to therapy depends on the severity, location, and time factors of the disease, but it can be divided into 2 groups: the so-called “rapid responders” are patients who respond quickly to drugs that are prescribed for vitiligo, and the so-called “nonresponders” are patients who do not respond to prescribed drugs.9
In some cases of vitiligo, such as segmental vitiligo, surgical procedures are recommended for patches resistant to therapy. Autologous melanocyte transplants have been used to treat vitiligo patches with tissue grafts, such as punch minigrafts,11,12 suction blister epidermal grafting,13 split-thickness grafting,14,15 and cellular grafting, which includes the transplantation of autologous epidermal cells suspension that comprise non-cultured melanocyte grafting17-21 and cultured autologous melanocytes.22 The early minigrafting technique is generally associated with numerous problems, including a deficient spread of the grafted melanocytes to the surrounding area and cobblestoning. The other surgical techniques are expensive and require sophisticated laboratories and personnel.
Therefore, the aim of the present study was to find a new melanocyte- grafting technique that used micrografts implanted with a needling technique in patients with different types of vitiligo at varying locations on their bodies.

PATIENTS AND METHODS

This interventional case study took place at the Department of Dermatology and Venereology at Baghdad Teaching Hospital from December 2010 to September 2011. Twelve patients with vitiligo were enrolled in this study (5 males and 7 females) and their ages ranged from 12 to 43 years with a mean ± standard deviation of 27.53 ± 9.78 years. All clinical types of vitiligo were treated, including generalized, localized, and segmental vitiligo. The number of vitiligo patches varied between patients, so the total number of treated patches was 24 (Table 1).

Inclusion Criteria

Segmental and localized areas of vitiligo were included. In patients with generalized vitiligo, localized areas were selected and treated because they were cosmetically unacceptable to the patients, requested by the patient, or a test area for further grafting. Each patient’s disease activity was recorded in order to monitor the duration of disease stability, and the patients were divided into 2 groups: (1) stable vitiligo, where there was no disease activity for more than 6 months before grafting and
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