Safety and efficacy of autologous melanocyte/keratinocyte transplantation in patients with refractory stable vitiligo

Background: Vitiligo is a common depigmentation skin disease associated with significant psychosocial morbidity and profound effect on the quality of life. The treatment of vitiligo is still a major challenge in the field of dermatology. Currently, topical steroids, calcineurin inhibitors, ultraviolet (UV) phototherapy, surgery, and cultured and non-cultured epidermal melanocyte transplantation are used for the treatment of vitiligo. However, the effectiveness of these treatment modalities is limited by the lack of response, long-term treatment periods, high cost and inevitable adverse effects. Objectives: In this study, we aimed to evaluate the efficacy of intraepidermal injection of autologous non-cultured melanocytes and keratinocytes as an alternative therapy for the refractory and stable (RS) vitiligo. Methods: The treatment procedure was performed on thirty-nine RS vitiligo patients. The autologous skin grafts obtained from buttock area and epidermis were separated from dermis using dispase. Single cell autologous melanocytes and keratinocytes were prepared from the epidermis by trypsin/EDTA and injected at the concentration of 100 to 400x 103 cells/cm2, intra-epidermally to the selected vitiligo lesions. Vitiligo re-pigmentation was monitored employing photography. Photographs were taken prior to and 2, 4, and 6 months after the cell transplantation. Improvement of the skin depigmentation was classified as following: <25% as minimal response, 26% to 50% as moderate response, 51-75% as good response and finally 76 to 100% as excellent response. Results: Cell infusion appeared to be safe as none of the patients exhibited any adverse effects. At the end of the sixth months follow-up period, of the treated patients, 12.8% demonstrated an excellent response, 36% exhibited a good response, and 51.2% showed a moderate to minimal response to the administered therapy. Obtained significant P value for Wilcoxon test over the check points at 2nd, 4th and 6th month (P= 0.03, 0.04 and 0.039, respectively) post-cell transplantation confirmed notable growing trend in the re-pigmentation. Conclusion: Our findings provide a strong support for the therapeutic efficacy of autologous non-cultured melanocytes and keratinocytes in patients with RS vitiligo.