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com
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Background











Treatment













Results




















Using ReCell for treating persistent
Hypopigmentation
A 35 year old female presented with persistent hypopigmentation.
Delayed wound healing after a chemical peel in 1995 resulted in
keloidal and hypertrophic scar formation with hypopigmentation on
the forehead and upper lip. Nineteen Erbium laser resurfacings
were then conducted over the next 10 years. This reduced the
hypertrophic scarring but did not diminish the patients
hypopigmentation

In 2005 ReCell was considered because of the persistent areas of
hypopigmentation, mainly on her upper lip, forehead and cheeks.
Under intravenous sedative anaesthesia, the entire face including the
ReCell recipient areas, was treated with Erbium laser resurfacing at 8
joules/cm
2
per pulse with a 5mm spot size. Double overlapping passes
were performed on the entire face giving a total fluence at any one site
of approx 48J . Four microns of ablation per J oule will ablate approx
180 to 200 microns of tissue.



Using plain lidocaine local anaesthetic, a 2cm
2
split thickness skin biopsy was harvested from the right
retroauricular area using a DermaBlade, and then processed using the ReCell system. The resultant cell
suspension was drizzled on the resurfaced skin in the areas of previous hypopigmentation. After this, low
adherent dressings were applied to the recipient sites (Urgotul, Urgo) followed by an absorbent fibrous fleece
(Kaltostat, Convatec). The tertiary dressing was a full face mask (Exudry adult face dressing, Smith & Nephew).

3 Months Post-Op 7 months Post-Op
RC14
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Results continued

Dressings were removed on Day 5 and the patient was instructed to lightly cleanse the face and use Eucerin
ointment liberally three times daily or as required until all scabbing had lifted.

Contrary to normal advice after laser resurfacing, the patient was instructed to attempt as much sun exposure as
possible.

At 3 months, re-pigmentation had occurred on up to 90% of her forehead and right cheek area, and somewhat less
on her upper lip.


Discussion

Hypopigmented scarring is reasonably refractory to treatment. The patient is unique in having gone through many
resurfacing procedures without substantial change to her hypopigmentation. This time, resurfacing followed by the
application of ReCell autologous cell suspension, with adequate postoperative sun exposure, was associated with
a marked improvement in her pigmentation.

The ReCell cell suspension contains a mixture of keratinocytes, fibroblasts and melanocytes amongst others. The
somewhat sparse supply of melanocytes in the suspension must first survive and multiply, perhaps with the aid of
ultraviolet light stimulation, before eventual repigmentation shows itself clinically.

Previous work has shown that autologous non-cultured cell preparations are able to repigment vitiliginous areas
1,2












References

1 van Geel N, Ongenae K, De Mil M, Naeyaert J M. Modified technique of autologous noncultured epidermal
cell transplantation for repigmenting vitiligo: a pilot study. Dermatol Surg. 2001;27:873-6
2 Mulekar SV, Al Issa A, Al Eisa A, Asaad M. Genital vitiligo treated by autologous, non-cultured
melanocyte-keratinocyte cell transplantation. Dermatol Surg. 2005;31:1737-9






Case study courtesy of Dr Greg Goodman, Melbourne, Australia
RC14