Melanocyte Transfer Technique : A Boon for Stable Vitiligo

By Dr. Suryakant Hayatnagarkar

M.D.(Pathology)

Cryocell India Pvt. Ltd, New Delhi

ETIOLOGY
Autoimmunity Neurohumoral Factors Autocytotoxicity

In India Vitiligo treatment is very important due to serious social stigma attached to disease
Un-treated patients suffer from social stigmatization Avoid social activities fearing negative reaction from others Tend to lag in developing potential at school or work due to social rejection

MEDICAL TRATMENT
Topical

corticosteroids Photochemotherapy Psoralen-UVA (PUVA) Narrowband UVB (Laser)

SURGICAL TREATMENT
Full

Thickness Punch Graft Suction Blister Graft Split thickness Graft

SURGICAL TREATMENT
Surgical treatment option of cultured or non cultured melanocyte keratinocyte transplantation is the best surgical option for stable vitiligo patches

CULTURED MELANOCYTE TRANSPLANTATION

Procedure requires highly sophisticated melanocyte culture laboratory and time gap between biopsy and transfer could range from 4 weeks to 8 weeks. Most important advantage is large area can be covered in one go from small biopsy sample.

NON CULTURED MELANOCYTE TRANSFER

Technologically simple to perform Requires very less equipment Basically it is a day care procedure Biopsy and Transfer procedures done on same day with time delay of only 3 hours Can be used to treat small lesions upto 100-150 sq. cm at a time

PATIENT SELECTION
Patient selection is very important for optimum results. This procedure is suitable for patients with
Small patches up to 100 sq cm. Stable patches not showing growth

for more than one year Patients requiring immediate cosmetic relief

MELANOCYTE TRANSFER TECHNIQUE

General surgical preparation is required Patient should be evaluated for surgical fitness and local/general anesthesia fitness. Xylocaine sensitivity should be carried out Donor site and the patches should be prepared for surgery by topical antiseptics

MELANOCYTE TRANSFER TECHNIQUE

Local xylocaine infiltration is used for the donor site anesthesia. Anterior or lateral thigh area or gluteal area is selected for taking biopsy. About 25 % of the area of patches to be treated is harvested as partial thickness skin graft Dermatome with disposable blade is used to harvest graft of 90 % thickness of epidermis

MELANOCYTE TRANSFER TECHNIQUE

The biopsy is collected without much bleeding. If bleeding occurs the graft is first washed in normal saline and then cut into small pieces of 3-6 mm size using sharp scissors. The biopsy pieces are collected in Cryocell Melanocyte medium with trypsin for further processing

MELANOCYTE TRANSFER TECHNIQUE

The sample is incubated in Cryocell Melanocyte medium for about 1.5-2 hours with intermittant agitation. The keratinoctytes and melanocytes will separate from epidermis The suspension is centrifuged to form cell pellet and then resuspended in patients own serum to inactivate enzymes.

MELANOCYTE TRANSFER TECHNIQUE

The patient is prepared for second procedure and either general or local anesthesia is used depending on requirement Dermabrasion is carried out using high speed dermabrador to the level of 90 % epidermis and till it shows pinpoint bleeding points

MELANOCYTE TRANSFER TECHNIQUE

All the patches selected to be treated are prepared by dermabrasion. 1-2 mm area beyond patch is also included to get perfect matching and avoiding ring white area. The suspension is trasnferred to the patches using disposable pipette

MELANOCYTE TRANSFER TECHNIQUE

Benzoin seal is applied 5-6 mm beyond the derm-abrasion area and the patches are covered by using dry collagen dressing and antibiotic gauze and then bandaged properly. The patient should avoid all types of tangential movements in the patch area for about 24 hours

MELANOCYTE TRANSFER TECHNIQUE

The dressing is opened after 6-7 days and depending on the condition redressing is applied or the patches are left open. Patient is given PUVA therapy after 15 days of transfer to get optimal results Re-pigmentation is evident in 3-4 weeks and is optimal in 3-6 months

CLINICAL CASES
BEFORE

AFTER

CLINICAL CASES
BEFORE

AFTER

RESULTS
Results of our series of 70 patients are promising
Complete results available for 16 patients

Complete cosmetic relief 85 % 90 % coverage of patches 15 % No relief One patient

The patient showing no relief was technical failure

CONCLUSIONS
Melanocyte transfer is very simple yet highly effective procedure for treatment of small stable vitiligo patches when immediate cosmetic relief is required. It can be performed in simple setups without elaborate instrumentation and demanding surgical skills.