Dr Sanjeev Mulekar - Specialist in Dermatology and the Treatment of Vitiligo


	Dr Sanjeev Mulekar During melanocyte-transfer procedure.

Before & After Pictures

Background: Melanocyte Transplantation
Melanocyte transplantation is the latest surgical method for the treatment of stable vitiligo / leucoderma and loss of pigmentation.

Melanocytes are the skin cells which produce melanin. A complete absence of skin colour usually means 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 in a suspension onto the damaged area of skin. This process is not a time consuming, laboratory cell culturing technique but is a process that can be carried out in a clinic in one to three hours. It is important to note that this is not a melanocyte culturing process.

Who is suitable for Melanocyte Transplantation?
There are two main categories of patients that are most suited to melanocyte transplantation.

a) Patients who have white patches on their skin as a result of leucoderma such as piebaldism and halo nevi or after laser tattoo removal or who have dischromia on burn scars.

b) Patients who have had stable vitiligo patches for a period of at least 6 months are good candidates to undergo melanocyte transplantation. Vitiligo patients should fulfill the following criteria to be eligible for surgery:
1. Existing patches should not have increased in size.
2. No new patches should have appeared on other areas.
3. Any injury should heal with normal skin color.

Response according to type of vitiligo:
1. Segmental - Best response and most suitable. Success rate 94% ( See below)
2. Focal - Very good response and suitable. Success rate 80%
3. Vulgaris - Responds well on lower extremity, poor response on face. Success rate 75%
4. Acral - Poor response in all areas. Success rate 20%

Success rate of treatment is 94% i.e. 94% of the treated patients develop pigmentation 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 patient.

Recurrence of vitiligo after treatment:
1. Segmental - Almost no recurrence
2. Focal - Minimal chance of recurrence. It can develop in vulgaris type.
3. Vulgaris - can recur.
4. 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. If affected area is large, patient has to undergo multiple
sessions.

Is one operative session enough for complete recovery?
Sometimes a few white spots remain. Approximately 30% patients require repeat surgery for complete recovery.

The Treatment

Most Advanced Method
Melanocyte transplantation is the most advanced surgical method to treat vitiligo / leucoderma. Large areas can be treated. Repigmentation occurs in about 4 to 6 months and cosmetic results are superior to other surgical methods such as skin grafting and punchgrafting. Difficult areas like bony surface, areola, genitals and knuckles can be treated with excellent results.

The operation step by step
1. A careful medical history and examination is recorded.
2. In a clean procedure room, a thin shave biopsy is taken under local anaesthesia. This is normally taken at the top of the thigh.
3. The biopsy is processed using an enzyme to separate the layers of skin and to make a skin cell suspension. This suspension contains melanocytes which produce the skin colour melanin.
4. The area to be treated is gently abraded, once again under local anaesthetic, and the skin cell mixture is applied. The skin cells immediately attach themselves and the healing and repigmentation process begins. The cells can do no harm as they are autologous ie the patient's own cells.

What happens post-treatment?
The treated site is protected by a dressing for one week. Verbal and written post treatment instructions are provided. Dependant on the site that was treated, no further dressing is required and you will need to follow the instructions that were given. There is usually no bruising or swelling. Some patients may feel minor discomfort at the biopsy and treated site for a few days which can be treated with a mild painkiller if wished. Recovery is remarkably quick.

When dressings are removed the treated area appears bright red. Repigmentation is seen only after 4 to 6 weeks in brown skin population and 8 to 12 weeks in Caucasians. It takes about 6 months to achieve maximum results.

Complications & Side Effects
1. Since no medicines are used except post-operative antibiotics, there are no side effects.
2. Scarring and Koebner's phenomenon are rare complications. Trauma of surgery may cause new lesions (Koebner's phenomenon) and is seen in approximately 2% of our patients. Use of oral prednisolone at surgery may prevent Koebner's phenomenon.
3. There may be a hypopigmented ring at the borders of treated and repigmented patches in some patients. Usually this ring disappears automatically or with application of local steroids, or by repeat surgery.
4. Bacterial infection. All patients are given oral antibiotics to prevent chances of infection.

Advantages of Melanocyte Transplantation
1. It is a day care procedure. Patient can go home in 3 to 5 hours.
2. A large area can be treated in one operative session.
3. 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 / leucoderma patches.
4. Very good cosmetic results.
5. Repigmentation is seen in 2 months and may take 4 to 6 months for maximum improvement and proper color matching.
6. Very minimal or no side effects.
7. No postoperative phototherapy required.

It is important to note that since no cause is known there is no permanent cure for the vitiligo / leucoderma. The disease can be treated so that pigmentation can reappear, but it cannot be cured from the roots.

There is no medicine which can prevent the spread of the disease or can prevent recurrences in future. It is wrong to believe that herbal medicines have no side effects. Hence it is not advisable to take medicines to prevent recurrences of disease for long periods and without full knowledge of their effects and side effects.