Melanocytes are the skin cells which produce melanin. A complete absence of skin colour usually means that the melanocytes have been destroyed. Thanks to an innovative treatment, it is now possible to take melanocytes from a healthy area of skin and transfer them as cellular suspension onto the de-pigmented patches of skin. This process can be performed in a clinic in one to three hours.
Who is suitable for Melanocyte Transplantation?
Clinically stable patient – Patients who have had stable vitiligo patches for a period of at least 1 year are good candidates to undergo melanocyte transplantation. Vitiligo patients should fulfill the following criteria to be eligible for surgery:
- Existing patches should not have increased in size.
- No new patches should have appeared on other areas.
- Any injury should heal with normal skin colour.
There are three main categories of patients that are suited to melanocyte transplantation.
- Segmental vitiligo
- Generalized vitiligo – Affected area < 20%
- Leukoderma- Piebaldism, post-burn leukoderma
Success rate of treatment is 94% i.e 94% of the treated patients when the repigmented area covers over 65% to 100% of the treated area. A statistical figure of success rate applies to a group of people and not to an individual.
Recurrence of vitiligo after treatment:
- Segmental – Rarely recurs.
- Focal – Low chance of recurrence. It can develop into vulgaris type however.
- Vulgaris – can recur.
- Acral – Very high rate of recurrence.
How much area can be treated?
In one operative session up to 100 cm2 white patches can be treated depending upon the sites involved. It can be up to 250 cm2 in selected patients. Multiple operative sessions are required for large areas.
- Local –Injection. Lidocaine 2% or Lidocaine cream or combination.
- General – used for multiple patches or if pain tolerance of the patient is low.
Is one operative session enough for complete recovery?
All patients do not achieve complete re-pigmentation in one session. Approximately 30% patients require repeat surgery to improve the results.
Most Advanced Method
Melanocyte transplantation is the latest modification in the surgical management of vitiligo/leukoderma. Large areas can be treated. Cosmetic results are superior to other surgical methods such as skin grafting and punch grafting. Difficult areas like bony surface, areola, genitals and knuckles can be treated with excellent results.
The operation step by step
- In a clean procedure room, a thin shave biopsy is taken. The most common site is anterior, upper third of thigh.
- The biopsy is processed using an enzyme to separate the layers of skin and to make a skin cell suspension. This suspension contains melanocytes-keratinocytes (epidermal cells).
- The area to be treated is abraded with diamond fraize wheel and the cell suspension is applied. It is covered with dry collagen sheet, which promotes healing.
- The final dressing consists of Micropore or Tegaderm depending on sites involved.
What happens post-treatment?
The treated site is protected by a dressing for one week. Verbal and written post treatment instructions are provided. Upon removal of dressing treated area appears bright red. Re-pigmentation begins in 4 to 8 weeks and continues to progress up to 4 to 6 months post surgery. Post operative pain depends upon the site and areas treated; feet being the most painful, and face the least.
Complications & Side Effects – are rare in expert hands.
- Scarring and Koebner’s phenomenon – Trauma of surgery may cause new lesions (Koebner’s phenomenon) and is seen in approximately 2% of our patients.
- Hypopigmented ring – at the borders of treated and re-pigmented patches in some patients. Usually this ring disappears automatically or with application of local steroids, or by repeat surgery. Rarely does it persist in spite of treatment.
- Bacterial infection. All patients are given oral antibiotics to prevent infection.
- Colour mismatch.
Advantages of Melanocyte Transplantation
- It is a day care procedure. Patient can go home immediately if local anaesthesia is used.
- A large area can be treated in one operative session.
- A very small piece of normal skin is sufficient to treat large affected area, e.g. 10cm2 of donor skin is enough to treat 100 cm2 of vitligo / leukoderma patches.
- Very good cosmetic results.
- Very minimal or no side effects.
- Postoperative treatment depends upon the response
It is important to note that since no cause is known there is no permanent cure for vitiligo / leukoderma. The disease can be treated to achieve re-pigmentation of vitiligo patches, but the vitiligo root cause cannot be cured.