Madhavilatha M¹, Thejaswi C^2*

¹Professor, ²Post Graduate Student, Department of Dermatology, Venereology and Leprosy, Santhiram Medical College, Nandyala, Kurnool Andhra Pradesh, INDIA.

Email: prabhakarrao10696@gmail.com

RESULTS

On removal of dressing on the recipient area, crusted scabs were seen partially attached to dermabraded area, along with erythematous achromic areas. Repigmentation usually started by 2- 3 weeks and was complete within 6 months in most of the patients. Earliest onset of pigmentation was observed within 10 days with pin-point pigmentation. In some patients with perifollicular type of repigmentation, initially islands of pigmentation was seen which later coalesced to form uniform repigmentation. Whereas in other patients, diffuse pigmentation was seen in central part of vitiliginous area, then gradually spread to pigment surrounding margins. Repigmentation was rapid and maximum in initial 3-4 months, then slowed in the following months. Repigmentation in donor area was of perifollicular type in all patients and was completed within 1- 6 months.

             Photo 1: Before procedure Photo1b: After dressing removal            Photo 1c: After 10 days of procedur Photo 1d: After 6 months

Photo 2a: Before procedure Photo 2b: After 6 months Photo 3a: Before procedure   Photo 3b: After 6 months

Photo 4a: Before procedure  Photo 4b: After 6 months Photo 5a : Before procedure            Photo 5b: After 6 months

   Photo 6a: Before procedure  Photo 6b: After 6 months

DISCUSSION

This procedure is also known by other names like non-culture melanocyte transfer, basal cell suspension technique, non-culture cellular transplant.7 The principle is seeding of melanocytes i.e. introduction of melanocytes from normal skin into a region of depigmented skin 8. The basic principle is to separate the basal cells and the melanocytes by trypsinization, and prepare a suspension which is applied on the dermabraded lesional skin 9. During the initial 7 days of healing, melanocytes and keratinocytes present in the grafted material, multiply and repigment the depigmented area. Further pigmentation can be accelerated by topical psoralen therapy 9, NBUVB and PUVA. However, some authorities use phototherapy only if there is delay in onset of repigmentation 6,10. Pigmentation in the treated areas gradually increases in size due to melanocyte proliferation and migration under the influence of cytokines secreted by surrounding keratinocytes. Hence, melanocytes taken from a small donor can pigment a much larger recipient area 9.A total of 30 patients were included in this prospective longitudinal study and followed up at 1 month, 3 months and 6 months. All patients completed the study.

Table 1: Age

Table 2: Sex

                                           Figure 1: Duration of stability                                     Figure 2: Associated Diseases

Sobhy13 et al found that the most important variable is the stability of the disease (2 years or more) rather than the duration of the disease. But, in the present study, patients with stability less than 2 years were also included according to IADVL task force guidelines regarding the stability.

In this study, association with only thyroid disease has been noted, 83.3% (25) patients had normal thyroid function tests, whereas 16.7% (5) patients had abnormal thyroid function tests. All 5 patients with abnormal thyroid function tests were females.

Figure 3: Subjective Assessment  Figure 4: Objective assessment

Figure 5: Overall EOP

After follow-up at 6 months, 10% (3) showed poor response, 30% (9) showed good response and60% (18) patients showed excellent response.

After follow-up at 6 months, 10% (3) showed poor response, 13.3% (4) showed fair response and% (7) patients showed good response, 53.3% (16) patients showed excellent response.Gauthier14 in study has reported incomplete repigmentation in 20% of patients, probably due to type of vitiligo.

After follow-up at 6 months 10% (3) showed poor response, 10% (3) showed fair response and20% (6) patients showed good response, 60% (18) patients showed excellent response.

Table 4:

AGE AT PRESENTATION VERSUS EXTENT OF PIGMENTATION AT 6 MONTHS

At the end of 6 months, excellent repigmentation was seen in 100% (5) patients in age group 11- 20 years and repigmentation observed was better and occurred earlier in younger patients than in older patients.Sobhy11 et al, also reported earlier repigmentation and better prognosis in age group <15 years than in older patients, probably due to younger cell that grows and multiplies rapidly.Czajkowski R9, also has found that the time of proliferation of melanocytes in invitro culture conditions depends on the age of the patient and, younger the patient, faster is the melanocytes proliferation.

ADVERSE EFFECTS IN DONOR AND RECIPIENT AREA

Though initially some patients developed hyperpigmentation and mild textural abnormality at donor site, after few months, they gradually decreased to match with surrounding area. Similarly, hyperpigmentation at recipient area too gradually decreased and they were not a significant causeof distress to the patients. Further, in this study, none of the patients had developed donor site infection, hypopigmentation and scarring.

CONCLUSION

In the present study, by subjective assessment, 10% (3) patients showed poor response, 30% (9) showed good response and 60% (18) patients showed excellent response after follow-up at 6 months with good patient satisfaction. By objective assessment 10% (3) patients showed poor response, 13.3% (4) showed fair response and 23.3% (7) patients showed good response, 53.3% (16) patients showed excellent response after follow-up at 6 months. Extent of repigmentation was evaluated as - 10% (3) showed poor response, 10% (3) showed fair response and 20% (6) patients showed good response, 60% (18) patients showed excellent response after follow-up at 6 months. Repigmentation was uniform, matched well with surrounding skin and usually completed within 6 months. Cosmetic acceptability is also superior as there is no cobble-stoning or scarring seen in other methods, giving good patient satisfaction. The study confirms that repigmentation by autologous non-cultured epidermal cell suspension in stable vitiligo is a safe, effective, and simple method, with superior quality of repigmentation, very few adverse effects and high level of patient satisfaction with possibility to repigment vitiliginous skin manifold larger than the donor skin.

REFERENCES

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