Comparison of Melanocytes Transplantation Methods for the Treatment of Vitiligo

BACKGROUND: Surgical therapy of vitiligo is indicated when depigmented macules are localized in areas that are known to respond poorly. OBJECTIVE: The objective was to compare the results of treatment of vitiliginous macules localized in the dorsum of the hands and lower limbs by transplantation of cultured autologous melanocytes plus PUVA therapy (CMP), suction blister transplantation plus PUVA therapy (SBP), cryotherapy plus PUVA therapy (CP), and only PUVA therapy (OP). METHODS: Twenty patients qualified for the study. The patients were split into two groups of 10 patients. In the first group, the CMP procedure was performed on one limb and OP on the other. In the second group, SBP and CP were used, respectively. RESULTS: The CMP procedure was successfully performed on only 6 of 10 patients, whereas SBP was carried out on all 10 patients. No significant difference was found between the number of successful transplants in both groups of patients. A total lack of effectiveness was found in CP and OP methods. CONCLUSION: This study demonstrated the advantage of the suction blister transplantation method over the autologous cultured melanocytes transplantation method because of the difficulties in cell culture establishment in some cases.     

Autologous Epidermal Cultures and Narrow-Band Ultraviolet B in the Surgical Treatment of Vitiligo

BACKGROUND: Vitiligo is an acquired skin disorder with a great social impact. It can be successfully treated with autologous epidermal grafting. OBJECTIVE: To evaluate the possibility of treating vitiligo by autologous grafting of epidermal cells and narrow-band ultraviolet B (UVB). METHODS: Autologous epidermal cultures were prepared starting from small biopsies of normally pigmented skin. Cells were cultured on hyaluronic acid membranes using medium supplemented with patient's serum. Cell cultures were grafted onto laser-abraded depigmented areas. Patients underwent narrow-band UVB therapy 3 weeks after grafting. RESULTS: Repigmentation of the grafted areas started 1 month after transplant and continued until 4 months after grafting. All patients were evaluated 3, 6, 12, and 18 months after grafting. At the 18-month follow-up, repigmentation was observed in 75% of patients with focal and segmental vitiligo and in 30% of patients with generalized vitiligo. CONCLUSIONS: This therapy can be considered for the treatment of stable vitiligo (especially focal and segmental) resistant to standard therapies. Their results are encouraging from the clinical and esthetic point of view, although the treatment is costly and highly specialized.     

Autologous Punch Grafting for Vitiligo of the Palm

BACKGROUND: Vitiligo of the palm can be resistant to conventional treatments, and grafting is not routinely attempted because of some difficulties. OBJECTIVE: To do a autologous minigraft test on a vitiligo patch on the palm using skin of the instep as the donor. METHODS: Under local anesthesia, two 2 mm minigrafts were transplanted into the vitiliginous skin of the palm of a 28-year-old female. Psolaren with ultraviolet A therapy followed the surgery for 12 weeks. RESULTS: Excellent repigmentation was seen around the grafts at the end of 12 weeks. There were no complications. CONCLUSION: The skin of the instep is an ideal donor site for palmar vitiligo.     

培养在壳聚糖-明胶膜片材料上人黑色素细胞的生物学特性初步研究

目的 研究培养在壳聚糖-明胶膜片材料上黑色素细胞的生物学特性.方法 取幼儿包皮,酶消化成单细胞悬液,接种后在黑色素细胞条件培养液中静置培养.黑色素细胞纯化、扩增后接种于壳聚糖-明胶膜片上.定期观察细胞形态变化及生长增殖情况,应用MTT测定、黑色素瘤抗体(Melan-A)免疫荧光染色、DOPA反应以判断黑色素细胞在壳聚糖-明胶膜片上的增殖及分化情况.结果 分离、纯化的黑色素细胞接种于壳聚糖-明胶膜片上生长良好,Melan-A免疫荧光染色及DOPA反应为阳性.结论 壳聚糖-明胶膜片是支持人黑色素细胞生长的良好材料,这一体系为色素脱失症的治疗提供了新的途径.     

Genital Vitiligo Treated by Autologous, Noncultured Melanocyte-Keratinocyte Cell Transplantation

Background. Genital vitiligo is common and has a deleterious effect on the psychosexual function of patients. It is well known that glabrous skin (non–hair-bearing skin such as below the ankles, genitalia, lips, distal ends of fingers) rarely responds to the therapy unless it has some residual pigment.
Objective. The objective was to report genital vitiligo treated successfully by autologous, noncultured, melanocyte-keratinocyte cell transplantation.
Methods. Three cases of clinically stable genital vitiligo were treated by autologous, noncultured melanocyte-keratinocyte cell transplantation.
Results. All lesions treated repigmented almost completely. All patients were very satisfied with the excellent cosmetic results.
Conclusion. Autologous, noncultured melanocyte-keratinocyte cell transplantation may be an effective surgical treatment for management of genital vitiligo.
SANJEEV V. MULEKAR, MD, AHMED AL ISSA, MD, ABDULLAH AL EISSA, MD, AND MARWAN ASAAD, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.     

Generative Surgery of Cultured Autologous Auricular Chondrocytes for Nasal Augmentation

Background  

Conventional treatment for nasal augmentation utilizes autologous grafts, allografts, or synthetic implants such as silicon implants. Silicon implants could protrude/expose or induce nasal bone resorption. Autologous grafts are usually associated with donor site morbidity and the volume of harvested tissue is limited. We had developed a new method for nasal augmentation using cultured autologous chondrocytes (CAC). The current report presents the results of a study using that method with a larger number of patients and an improved graft technique for the nasal tip.     

Successful Treatment of Extensive Vitiligo with Monobenzone

Vitiligo is one of the most common dermatological disorders, appearing as one or more white macules or patches and affecting up to two percent of the population worldwide. The undesirable aesthetic properties of vitiligo, especially facial, may result in significant negative psychosocial effects, particularly a rate of depression twice that of the general population. While there is no cure, there are several treatment options, notably depigmentation in severe cases. Monobenzone is the most potent depigmenting agent. However, its use is limited due to the permanent and potent nature of the drug. This case presents an example of when timely and aggressive treatment with monobenzone is warranted, demonstrating excellent clinical response, which resulted in a significant increase in the quality of life in a patient with severe vitiligo.Vitiligo is among one of the most common dermatological disorders, affecting up to two percent of the population worldwide.1,2 A chronic and usually progressive disorder, vitiligo presents discretely before 20 years of age, although first presentation in later life may occur as well.2 Clinically, it appears as one or more well-circumscribed, hypopigmented, white macules or patches. This is due to the acquired autoimmune destruction of melanocytes, most often in areas of greater pigmentation, such as the face and dorsum of the hands where they are most exposed to UV radiation.2 Apart from the cosmetic appearance, it is usually asymptomatic, although there is a greater tendency for sunburns and pruritis.2The undesirable aesthetic properties of vitiligo, especially facial, may result in significant negative psychosocial effects, notably a rate of depression twice that of the general population.3 In some cultures, vitiligo is not well understood. The depigmentation of vitiligo is thought to result from sexually transmitted infections, or of leprosy, and can have a damaging effect on educational, social, and employment opportunities.1,2,4 Patients may feel embarrassed or ashamed of such a visible disorder. Studies have shown that vitiligo is associated with a greater burden of disease to patients, especially those in populations with dark skin.1,2,4 Therefore, treatment, although not medically necessary, provides large psychosocial gains for the patient, increasing their quality of life.There is no cure for vitiligo. Current treatment for vitiligo attempts to either increase or decrease pigmentation in order to achieve cosmetically pleasing results and increase the patient''s self-esteem.5 Repigmentation tends to require a prolonged treatment course and yield minimal positive results.6 Strong topical steroids are generally the first line of treatment, with only a 50- to 75-percent repigmentation rate.5,6 Tactrolimus, an immunosuppressive, and calcipotriene, a vitamin D analogue, are alternative topical repigmenting agents, with a similar efficacy as the topical steroids.6 When such treatment fails, psoralen plus ultraviolet A radiation (PUVA) and narrow-band ultraviolet B radiation (NB-UVB) are effective alternatives.5,6 However, PUVA can be carcinogenic and NB-UVB has low efficacy; both require prolonged treatments.6,7 Alternative treatments exist, such as melanocyte transplantations. However, despite the type of treatment, repigmentation still remains difficult and time consuming, especially with advanced vitiligo.Due to the difficulties with repigmentation, it is often easier to achieve depigmentation, especially when vitiligo affects more than 50 percent of the body.5–7 It is, however, a more aggressive approach and its use is considered on an individual basis because of the irreversible changes and increased sensitivity to sunburn of the treated areas. Several treatment modalities exist. Phenols, lasers, cryotherapy, and depigmenting systemic agents, such as imatinib, imiquimod, and diphencyprone, are often considered.7 Monobenzone (monobenzyl ether of hydroquinone, MBEH) is usually the treatment of choice of depigmentation therapy for severe cases of vitiligo, and MBEH is usually used in concentrations of 20 to 40 percent to achieve the desired permanent depigmentation.5,7 It achieves its effects by inducing the necrotic death of melanocytes.7 Topical all-trans-retinoic acid (RA), a vitamin A derivative, causes mild depigmentation and when used in combination with MBEH, has synergistic effects, yielding depigmentation in a short amount of time.7 Nair et al8 have proposed that the RA enhances the absorption of monobenzone by melanocytes through the inactivation of their glutathione-dependent defense mechanisms.7,8 Side effects of MBEH include skin irritation, contact dermatitis, ocular side effects, exogenous ochronosis, and difficulties in predicting response.5,9–11 There can be repigmentation because of sun exposure or rarely as a reaction to the drug.5,7,10,11 Due to these side effects, MBEH treatment can be somewhat controversial, and its use has been limited in some countries, such as the Netherlands, which has restricted it since 1990.7 MBEH has been approved by the United States Food and Drug Administration since 1952 for permanent depigmentation of extensive vitiligo.     

Modified Technique of Autologous Noncultured Epidermal Cell Transplantation for Repigmenting Vitiligo: A Pilot Study

BACKGROUND: Several reports have demonstrated that grafting of autologous melanocytes from normally pigmented donor skin can be used for repigmentation of achromic macules in vitiligo. OBJECTIVE: To investigate a modified approach in which noncultured autologous melanocytes and keratinocytes are grafted on superficially laser dermabraded vitiligo lesions in a suspension enriched with hyaluronic acid. METHODS: Four patients with stable vitiligo were treated using a noncultured melanocyte-keratinocyte suspension. The cellular suspension was grafted on vitiliginous lesions previously dermabraded with a CO2 laser. To improve the viscosity and fixation of the cellular suspension hyaluronic acid was added. Three weeks after grafting, psoralen plus ultraviolet A (PUVA) or ultraviolet B (UVB) therapy was started. Residual leukodermic areas were subsequently retreated. RESULTS: Repigmentation was observed within 2-4 weeks and continued to increase for 3 months after treatment. In all patients, 85-100% repigmentation was achieved. A temporary slight color mismatch was visible in all patients. The most homogeneous repigmentation was obtained 5 months after treatment. CONCLUSION: This modified procedure seems to be a simple and promising treatment for larger vitiliginous areas.     

Epidermal Grafting After Chemical Epilation in the Treatment of Vitiligo

BACKGROUND: Vitiligo on hairy areas like the scalp and eyebrows is frequently associated with leukotrichia and repigmentation by photochemotherapy is usually difficult because of a deficient melanocyte reservoir. Although epidermal grafting to supply melanocytes is very effective for stable vitiligo, hair growth inhibits successful transfer of melanocytes from grafted epidermis in dense hair-bearing regions. OBJECTIVE: To investigate the effectiveness of preoperative chemical epilation to improve the results of epidermal graft by suction blister on hairy areas. METHODS: Two patients who had vitiligo with leukotrichia on the face and scalp were treated with epidermal grafting using suction blister after chemical epilation. Two weeks after the graft they were treated with topical psolaren plus ultraviolet A (PUVA) therapy. RESULTS: Epidermal grafting was performed successfully, and successful repigmentation of the skin with significant improvement of leukotrichia was observed in each of two patients. CONCLUSION: Chemical epilation followed by epidermal grafting is a safe, easy, and effective treatment for vitiligo affecting hairy regions.     

Clinical Application of Biotechnically Cultured Autologous Chondrocytes as Novel Graft Material for Nasal Augmentation

A new method of nasal augmentation has been developed, in which cultured autologous chondrocytes are transplanted. Using biotechnology, a piece of the choncha cartilage 1 cm² is cultured into a gel-type mass of chondrocytes, which then is transplanted by injection into a surgically created subperiosteal skin pocket on the nasal dorsum. The augmented nose is taped and protected for 1 week. The grafted chondrocytes develop into mature cartilaginous tissue after approximately 1 month. This method was used in eight cases of nasal augmentation, and one case of chin augmentation (performed simultaneously), and one case of depressed deformity on the forehead. The results obtained by this method to date have been satisfactory after a follow-up time of 6 to 24 months. The authors believe that this method may at least partially be able to replace silicone implantation for nasal augmentation.     

Stable Vitiligo Treated by a Combination of Low-Dose Oral Pulse Betamethasone and Autologous, Noncultured Melanocyte-Keratinocyte Cell Transplantation

BACKGROUND: Various surgical procedures are in use to treat stable vitiligo. The possibility of Koebner phenomenon always exists with surgical treatment. Partial or complete failure to repigment is observed in spite of clinical stability. AIM: To evaluate the usefulness of a combination treatment of low-dose oral betamethasone and melanocyte-keratinocyte transplantation. METHODS: Oral betamethasone was given to patients who failed to respond either completely or partially to melanocyte-keratinocyte cell transplantation, and the procedure was repeated for previously treated and nontreated area. A simpler and modified method described by Mulekar was performed. RESULTS: Seventeen patients with vitiligo vulgaris and eight patients with segmental vitiligo were retransplanted after giving oral betamethasone for 2 to 10 months after the initial procedure. Two patients of vitiligo vulgaris and one of segmental vitiligo failed to respond completely even after repeat transplantation. Fifteen vulgaris and seven segmental patients showed excellent to good repigmentation after repeat transplantation. CONCLUSION: Combined treatment of oral betamethasone and melanocyte cell transplantation has a potential to produce complete repigmentation in patients with large vitiliginous areas.     

光疗法与免疫调节在白癜风治疗中的应用效果

比较光疗法与免疫调节在白癜风治疗中的应用效果。方法 选取寿光市皮肤病防治站 2021年10月-2023年10月收治的130例白癜风患者为研究对象,采用随机数字表法均分为对照组与观察 组,每组65例。对照组采用免疫调节治疗,观察组采用光疗法治疗,比较两组临床疗效及不良反应发 生情况。结果 观察组治疗总有效率为95.38%,高于对照组的86.15%,差异有统计学意义（P＜0.05）;观 察组不良反应发生率低于对照组,差异有统计学意义（P＜0.05）。结论 光疗法和免疫调节治疗白癜风均 可达到治疗目的,但光疗法效果更佳,且不良反应发生风险较低,值得临床应用。     

全程护理模式对白癜风患者自体表皮移植术疗效及术后生活质量的影响

分析全程护理模式在白癜风患者自体表皮移植术中的应用效果及对生活质量的影响。 方法 选择2022年1月-2023年1月贵州医科大学附属医院皮肤科收治的100例白癜风自体表皮移植术患者为 研究对象，随机分成参照组与试验组，各50例。参照组实施常规性术后护理模式，试验组实施全程护理 模式，比较两组护理效果、术后疼痛情况及生活质量。结果 试验组护理总有效率为98.00%，高于参照组 的84.00%（P ＜0.05）；试验组疼痛（NRS）评分低于参照组（P ＜0.05）；试验组生活质量（SF-36）各 项评分均高于参照组（P ＜0.05）。结论 全程护理能够让自体表皮移植术后的白癜风患者改善机体的皮肤 状态，可以提高患者的恢复速度，减轻疼痛，改善患者生活质量，值得应用。     

他克莫司软膏联合米诺地尔酊治疗白癜风的效果

目的 观察他克莫司软膏联合米诺地尔酊在白癜风患者治疗中的应用效果。方法 选取2022年 5月-2023年5月我院收治的72例白癜风患者为研究对象,采用随机数字表法分为对照组和观察组,各组 36例。对照组采用米诺地尔酊治疗,观察组采用他克莫司软膏联合米诺地尔酊治疗,比较两组临床疗效、 不良反应发生情况、白斑面积及生活质量。结果 观察组治疗总有效率为94.44%,高于对照组的80.56%,差 异有统计学意义（P＜0.05）;观察组不良反应发生率为8.33%,低于对照组的11.11%,但差异无统计学意义 （P＞0.05）;两组治疗后白斑面积均小于治疗前,且观察组小于对照组,差异有统计学意义（P＜0.05）;两组 治疗后DLQI评分均低于治疗前,且观察组低于对照组,差异有统计学意义（P ＜0.05）。结论 他克莫司 软膏联合米诺地尔酊外涂治疗白癜风的效果理想,可提高治疗总有效率,减小白斑面积,改善患者的生活 质量,且不会增加不良反应发生风险,可作为一种可行、有效、安全的治疗方法加以应用。     

CO2点阵激光联合他克莫司治疗白癜风患者的疗效

探讨CO2点阵激光联合他克莫司治疗白癜风的临床效果。方法 选择2020年1月-2023年10月 我院收治的白癜风患者94例为研究对象,采用简单抽样法分为对照组和观察组,各47例。对照组采用 他克莫司软膏治疗,观察组在对照组基础上联合CO2点阵激光治疗,比较两组白癜风皮损面积与严重 指数评分（VASI）、白癜风活动性评分（VIDA）、皮损分布评分、炎症因子水平（TNF-α、ICAM-1、 IL-17、TGF-β1）及不良反应发生率。结果 观察组干预4周后VASI、VIDA及皮损分布评分低于对照组 （P ＜0.05）;观察组干预4周后TNF-α、ICAM-1、IL-17及TGF-β1水平低于对照组（P ＜0.05）;两 组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论 CO2点阵激光联合他克莫司治疗白癜风的 效果较好,能减轻临床症状及皮损分布情况,降低体内炎症反应,且治疗安全性较高。     

自体骨髓干细胞移植治疗血栓闭塞性脉管炎

目的探讨自体骨髓干细胞移植治疗血栓闭塞性脉管炎（TAO）的疗效及安全性。方法对13例TAO患者（17条患肢）行自体骨髓单个核细胞（BM-MNC）肌注移植术,采用主观指标包括患肢疼痛和冷感以及客观指标包括踝肱指数（ABI）、经皮氧分压（TcPO2）和足部溃疡变化进行疗效评价。结果移植治疗2个月后疼痛缓解者15条,冷感缓解者16条。移植前ABI为0.37±0.06,移植治疗后2个月为0.50±0.17（P〈0.05）,ABI改善者9条。TcPO2移植治疗前为（24.59±3.36）mmHg（1mmHg=0.133kPa）,移植治疗后2个月为（35.00±10.44）mmHg（P〈0.05）,TcPO2改善14条。溃疡改善者7条。经4～18个月（平均8个月）随访,患者主观症状改善者13条;客观指标ABI为0.45±0.14,与移植治疗前和移植治疗后2个月比较,差异均无统计学意义（P〉0.05）;TcPO2为（33.24±10.43）mmHg,与移植治疗前和移植治疗后2个月比较,差异有统计学意义（P〈0.05）,改善率为70.6%（12/17）。溃疡愈合者5条,有2例2条患肢的溃疡伴疼痛无缓解,无死亡及高位截肢者。所有患者经常规检查未发现视网膜增生、恶性肿瘤、心肌梗塞、脑梗塞、血管瘤形成等并发症。结论自体骨髓干细胞移植是一种安全、有效的治疗TAO手段,改善患肢症状及促进溃疡愈合。     

Punch Grafting versus Suction Blister Epidermal Grafting in the Treatment of Stable Lip Vitiligo

BACKGROUND Among surgical methods, punch skin grafting (PSG) and suction blister epidermal grafting (SBEG) are simple, inexpensive, and effective treatment methods for resistant lip vitiligo cases, but there is a lack of comparison between these procedures for lip vitiligo.
OBJECTIVE The objective was to compare the outcome following PSG and SBEG in stable lip vitiligo.
METHODS Eighteen patients with stable lip vitiligo were randomly selected. Eight patients were included in PSG group and 10 patients in SBEG. All patients were kept on PUVA-SOL (psoralen+ultraviolet A therapy of solar origin) treatment after grafting. The results were evaluated after a follow-up period of 6 months.
RESULTS At the end of 6 months of grafting in PSG group, two patients had a repigmentation of 50% to 75%, one had 75% to 90%, and three had 90% to 100% in the recipient site in lip. In SBEG group, one patient had repigmentation of 50% to 75%, three had 75% to 90%, and two had 90% to 100%. The color match was statistically significant in PSG when compared to SBEG. In the recipient site, cobblestone appearance was the predominant complication in PSG whereas hyperpigmentation and thickening of grafts were common in SBEG. In the donor site, superficial scarring and hypopigmentation were the common findings in PSG group whereas hyperpigmentation was the main problem in SBEG group.
CONCLUSIONS Although both the procedures are effective in lip vitiligo, PSG gives a better color match than SBEG.