Oct 18 2004
Patients with stable vitiligo, a skin disorder characterized by patches of lighter colored, or depigmented skin, may achieve good repigmentation of these areas with skin transplants using skin taken from normally-pigmented areas of their own bodies, according to two articles in the October issue of The Archives of Dermatology, one of the JAMA/Archives journals.
According to the articles, vitiligo is one of the most common pigment cell disorders, distinguished by depigmented patches of skin. Approximately one percent of the world population has vitiligo, whose psychosocial impact is often underestimated, the article states. The standard treatment for vitiligo is ultraviolet (UV) light therapy, which may last several months and can cause physical discomfort. Transplantation of pigment cells (called melanocytes) is another treatment option in patients with vitiligo.
Nanny van Geel, M.D., of Ghent University Hospital, Belgium, and colleagues investigated the efficacy of using transplanted pigment cells to treat 28 patients with vitiligo.
Patients were divided into two groups: patients with stable vitiligo (no new depigmented patches in the past 12 months, n=19) and patients whose vitiligo was not stable (n=9). The researchers selected 33 pairs of depigmented skin patches on the patients- one patch was randomly assigned to be treated with grafted pigment cells, the other was given a sham transplant. Pigment cells were taken from each patient from a site where the skin was normally pigmented. Three weeks after surgery, all patches received UV irradiation therapy twice per week for approximately two months.
The researchers found that there was a significant difference between pigment cell graft sites and placebo graft sites after three, six and 12 months. In patients with stable vitiligo, repigmentation of at least 70 percent of the treated area was achieved in 55 percent, 57 percent, and 77 percent of the actively treated lesions at three, six and twelve months after treatment. In group two, repigmentation of at least 70 percent of the treated area was not achieved at any time point. Repigmentation was diffuse on 94 percent of responding patients.
“After a strict preoperative selection for disease stability, transplantation resulted in repigmentation of at least 70 percent of the treated area in most actively treated vitiligo lesions,” the authors write.
In another study, Sanjeev V. Mulekar, M.D., of the Noble Clinic, Pune, India investigated the long-term efficacy of skin cell transplantation in 67 patients with vitiligo. Dr. Mulekar used a melanocyte-keratinocyte cell mixture (pigment cells and structural skin cells) taken from normally-pigmented sites on the patients’ own bodies. Patients were followed up for five years.
Dr. Mulekar found that 41 patients (84 percent) with segmental vitiligo (located in a few similar locations on each side of the body, such as around the mouth or on the hands) had 95 percent to 100 percent repigmentation in the treated areas. In patients with focal vitiligo, 73 percent had 95 percent to 100 percent repigmentation in treated areas. These results remained throughout the follow-up period.
“Melanocyte-keratinocyte cell transplantation is a simple, safe, and effective surgical therapy,” Dr. Mulekar writes. “Patients with segmental and focal vitiligo can experience a prolonged disease-free period, which may extend through the rest of their lives.”
In an accompanying editorial, Mats J. Olsson, Ph.D., of Uppsala University, Sweden, writes, “Patchy loss of skin pigmentation can have significant consequences for affected individuals, who often experience difficulty functioning as socially active individuals and may not achieve the lifestyle they desire simply because they have white spots on their skin. In some countries with a predominantly dark-skinned population, leukoderma (white skin) can result in social stigmatization, leading to major difficulties in getting married and obtaining work.”
Dr. Olsson writes that in stable types of vitiligo, “… the outcome of transplantation therapy is usually excellent; in some cases, transplantation may indeed be the only effective treatment. However, the long-term experience with both surgical and medical treatment of generalized vitiligo that we have acquired in Uppsala has made us very conservative regarding patient selection, and we now most often decline requests for transplantation therapy in patients with generalized vitiligo,” states Dr. Olsson.
“Unfortunately, as yet there is no reliable test to predict the activity and outcome of melanocyte transplantation treatment in patents with generalized vitiligo,” he writes.
Dr. Olsson concludes that “It must be stressed that it is important to help patients with leukoderma, as they often suffer severely from their skin disorder. However, we must know that there exists no treatment totally free from possible adverse effects,” he writes. “Although the medical alternatives offered to these patients, such as different kinds of UV therapies and corticosteroid treatments, are not totally free from undesirable side effects, they still serve as important segments in the circle of alternatives. And if used for the appropriate indications and in the right circumstances, surgical treatments represent an important strategy to restore pigmentation in skin that has lost its melanocytes, and it will most likely continue to serve this purpose for many more years.”