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Evaluating the Long-Term Efficacy of Cultured Melanocyte Transplantation in Stable Vitiligo

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The study found that CMT is effective and well-tolerated in treating stable vitiligo, with significant positive correlations between the target area treatment ratio and repigmentation.

Autologous cultured pure melanocyte transplantation (CMT) is effective and well-tolerated in individuals with stable vitiligo, more specifically on a long-term basis, according to a recent study published in The Journal of Dermatology.1

Researchers found that among patients with stable vitiligo, 69.7% those who had received CMT achieved excellent repigmentation, and 18.4% achieved good repigmentation.

Vitiligo surgery
Image Credit: © DermNet

Previous studies by researchers Hong et al, including a 2011 study published in the British Journal of Dermatology, reported that autologous CMT led to favorable outcomes in patients with stable vitiligo.2

However, present study authors Lin et al noted that while several papers have reported the effectiveness of CMT in stable vitiligo, the majority employed small sample sizes, with few analyzing the factors influencing transplantation outcomes. Now, researchers aimed to provide a detailed analysis of the long-term efficacy of CMT in treating vitiligo.

Background and Methods

The study included 491 patients treated with CMT between June 2009 and June 2018, with follow-ups extending to June 2020. The inclusion criterion was stable vitiligo defined as the presence of static lesions for at least 6 months and absent Koebner phenomenon, as well as a history of non-response to conventional topical and systemic treatments. Patients with a history of keloid formation, bleeding diathesis, or pregnancy were excluded from participation.

Melanocytes were harvested from normally pigmented skin on the abdomens or buttocks using a vacuum blister technique. The cells were then cultured in a specialized medium and subcultured to obtain sufficient numbers for transplantation. Prior to the procedure, recipient areas were prepped with local anesthetic cream and cleaned with 70% alcohol. A superpulsed CO2 laser was used to remove the epidermis from the recipient area, and melanocytes were transplanted at a concentration of 600–1000 cells/mm².

Key Takeaways

  • CMT shows high efficacy for stable vitiligo, with significant repigmentation achieved in most cases.
  • Vitiligo stability, type, and transplant site greatly impact outcomes.
  • CMT is generally safe, with ongoing research focusing on optimizing outcomes through additional treatments.

Findings

The study included patients with vitiligo durations ranging from 1 to 30 years, with an average duration of 6.5 years. Of the patients, 176 had segmental vitiligo and 315 had non-segmental vitiligo. The most commonly transplanted sites were the face, neck, and back of the hands.

Repigmentation outcomes were categorized as excellent (>90%), good (50%–89%), fair (20%–49%), and poor (<20%).

The study found that 59.7% of lesions showed excellent repigmentation, 18.4% showed good repigmentation, 12.8% showed fair repigmentation, and 9.2% showed poor repigmentation.

The overall effective rate (repigmentation ≥50%) was 78%.

A regression analysis revealed that the type and stability of vitiligo significantly influenced repigmentation outcomes. Age and the specific area of transplantation were also relevant but to a lesser extent. Patients with stable vitiligo for over 12 months had significantly better outcomes compared to those with less stable vitiligo.

The face and neck areas showed the highest repigmentation rates, while hands and feet had the lowest. This variation can be attributed to differences in skin characteristics and microenvironments across different body parts, researchers noted.

Three patients experienced local infections, which were effectively managed with antibiotics. No other significant adverse events, such as hypersensitivity or scar hyperplasia, were observed.

Conclusions

The study confirmed that stable vitiligo, especially segmental vitiligo, responds better to CMT. This could be due to the easier stabilization of leukoplakia in segmental vitiligo compared to the broader and more complex nature of nonsegmental vitiligo, according to researchers.

The longer the stability period, the better the repigmentation outcomes, emphasizing the importance of stability as a selection criterion for CMT.

The study also highlighted the importance of considering the transplant area and ratio to improve repigmentation outcomes. Lin et al suggested that future research could further refine these variables to enhance the efficacy of CMT.

"Our findings suggest that CMT is a viable alternative for patients with vitiligo refractory to medical therapy. Various factors, such as disease stability duration, vitiligo type, and lesion site, should be carefully evaluated before use, as these factors further influence postoperative pigmentation," they wrote. "In particular, the selection of the transplant area and transplant proportion will greatly impact the success and recoloration rates of the transplant and affect efficacy and satisfaction."

Moving forward, Lin et al plan to investigate the use of anti-inflammatory or corticosteroids/systemic steroids treatments and their role in the efficacy of CMT.

References

  1. Lin F, Wang Y, Zheng Y, et al. Target area treatment ratio of varied lesions in the cultured pure melanocyte transplantation repigmentation of vitiligo: A retrospective study. J Dermatol. Published online June 19, 2024. https://doi.org/10.1111/1346-8138.17320
  2. Hong W, Hu D, Qian G, McCormick SA, Xu A. Ratio of size of recipient and donor areas in treatment of vitiligo by autologous cultured melanocyte transplantation. Br J Dermatol. 2011; 165: 520–525.
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