Simplified Non-cultured Non-trypsinised Epidermal Cell Graft Technique Followed by Psoralen and Ultraviolet A Light Therapy for Stable Vitiligo

Abstract

Background and aims: Stable vitiligo can be treated by various surgical procedures. Non-cultured melanocyte grafting techniques were developed to overcome the time-consuming process of culture while at the same time providing acceptable results. All the techniques using non-cultured melanocyte transfer involve trypsinisation as an integral step. Jodhpur technique used by the author is autologous, non-cultured, non-trypsinised, epidermal cell grafting.

Settings and design: The study was conducted on patients visiting the dermatology outpatient department of a tertiary health centre in Western Rajasthan.

Materials and methods: At the donor site, mupirocin ointment was applied and dermabrasion was done with the help of micromotor dermabrader till pinpoint bleeding was seen. The paste-like material obtained by this procedure containing melanocytes and keratinocytes admixed with the ointment base was harvested with spatula and was subsequently spread over the recipient area. Recipient site was prepared in the same manner by dermabrasion. After 10 days, dressing at both sites was removed taking utmost care at the recipient site as there was a theoretical risk of dislodging epidermal cells.

Results: In a study of 437 vitiligo patches, more than 75% re-pigmentation (excellent improvement) was seen in 41% of the patches. Lesions on thigh (100%), face (75%) and trunk (50%) showed maximal excellent improvement, whereas patches on joints and acral areas did not show much improvement.

Conclusions: This technique is a simplified, cost effective, less time-consuming alternative to other techniques which involve tryspsinisation of melanocytes and at the same time provides satisfactory uniform pigmentation.

Keywords: Vitiligo; dermabrasion; grafting; non-cultured; non-trypsinised; surgical treatment.

Figure 1

Histopathology of the graft material, showing abundance of melanocytes (Fontana-Masson, ×100)

Figure 2

Graft material spread homogeneously at the recipient site

Figure 3

(a) Pre-operative picture. (b) Post-operative picture, 20 weeks post-procedure showing almost complete repigmentation

Figure 4

(a) Pre-operative picture. (b) Post-operative picture

Figure 5

(a) Pre-operative picture. (b) Post-operative picture showing partial repigmentation

Figure 6

(a) Pre-operative picture. (b) Post operative picture showing keloid in the lateral half treated with split thickness skin graft, no keloid formation in the medial half treated with Jodhpur technique