Vitiligo and Piebaldism : Treatmant of Leucoderma by Transplantation of autologous melanocytes

Sammanfattning: Background: Vitiligo and piebaldism are disorders in which the affected skin lack epidermal melanocytes. Vitiligo is acquired and can clinically be subgrouped, but the aetiology is still not fully understood. The most common type, generalized vitiligo (vitiligo vulgaris) has autoimmune involvement and affects about 1.5% of the population around the world. Piebaldism is an inherited autosomal dominant, congenital disorder, affecting about 1:14,000 individuals and seen in all races. The options for treating some of these leucodermic lesions have been sparse.Methods: Three new models of transplanting autologous melanocytes from normally pigmented skin into denuded leucodermic areas have been established: (1) expansion of melanocytes from a shave biopsy by culture under serum-free conditions, (2) transfer of ultra-thin epidermal sheets from pigmented skin, and (3) transplantation of a suspension of basal epidermal cells obtained from a shave biopsy.The treatment outcome in a short perspective was supplemented with a long-term follow-up study in 132 patients treated with one or several of these methods on a total of 176 occasions between 1993 and 1999. The results of the transplantations were related to the method used, anatomical distribution of the lesions, disease duration, progression of the lesions, extent of vitiligo and associated diseases.Results: Patients with stable forms of leucoderma, i.e., segmental vitiligo, focal vitiligo and piebaldism, almost always respond with a complete repigmentation regardless of the method used and with no loss of pigmentation seen at follow-up several years post-surgery. Patients with extensive and unstable vitiligo vulgaris were less often fully repigmented. Several vitiligo vulgaris patients had experienced some loss of pigmentation in the treated areas. Vitiligo vulgaris patients treated with the three different methods displayed at follow-up an average percentual pigmentation of the treated areas as follows: cultured melanocytes 42%, 6.6 years post-surgery (y ps), ultra-thin epidermal sheets 59%, 4.2 y ps, and basal-layer suspension 49%, 3.48 y ps, respectively.Conclusion: Autologous melanocyte transplantation is an effective option for obtaining repigmentation in patients with stable leucoderma.

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