Micropunch grafting as an adjuvant for noncultured melanocyte-keratinocyte transplantation for refractory vitiligo

IMPORTANCE Surgical interventions are a key part of the therapeutic arsenal, especially in refractory and stable vitiligo. Comparison of treatment outcomes between the different surgical procedures and their respective adverse effects has not been adequately studied.OBJECTIVE To investigate the reported treatment response following different surgical modalities in patients with vitiligo.DATA SOURCES A comprehensive search of the MEDLINE, Embase, Web of Science, and Cochrane Library databases from the date of database inception to April 18, 2020, was conducted. The key search terms used were vitiligo, surgery, autologous, transplantation, punch, suction blister, and graft.STUDY SELECTION Of 1365 studies initially identified, the full texts of 358 articles were assessed for eligibility. A total of 117 studies were identified in which punch grafting (n = 19), thin skin grafting (n = 10), suction blister grafting (n = 29), noncultured epidermal cell suspension (n = 45), follicular cell suspension (n = 9), and cultured epidermal cell suspension (n = 17) were used.DATA EXTRACTION AND SYNTHESIS Three reviewers independently extracted data on study design, patients, intervention characteristics, and outcomes. Random effects meta-analyses using generic inverse-variance weighting were performed. MAIN OUTCOMES AND MEASURESThe primary outcomes were the rates of greater than 90%, 75%, and 50% repigmentation response. These rates were calculated by dividing the number of participants in an individual study who showed the corresponding repigmentation by the total number of participants who completed the study. The secondary outcomes were the factors associated with treatment response to the surgical intervention. RESULTS Among the 117 unique studies and 8776 unique patients included in the analysis, rate of repigmentation of greater than 90% for surgical interventions was 52.69% (95% CI, 46.87%-58.50%) and 45.76% (95% CI, 30.67%-60.85%) for punch grafting, 72.08% (95% CI, 54.26%-89.89%) for thin skin grafting, 61.68% (95% CI, 47.44%-75.92%) for suction blister grafting, 47.51% (95% CI, 37.00%-58.03%) for noncultured epidermal cell suspension, 36.24% (95% CI, 18.92%-53.57%) for noncultured follicular cell suspension, and 56.82% (95% CI, 48.93%-64.71%) for cultured epidermal cell suspension. The rate of repigmentation of greater than 50% after any surgical intervention was 81.01% (95% CI, 78.18%-83.84%). In meta-regression analyses, the treatment response was associated with patient age (estimated slope, −1.1418), subtype of vitiligo (estimated slope, 0.3047), and anatomical sites (estimated slope, −0.4050). CONCLUSIONS AND RELEVANCEThe findings of this systematic review and meta-analysis suggest that surgical intervention can be an effective option for refractory stable vitiligo. An appropriate procedure should be recommended based on patient age, site and size of the lesion, and costs.

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“…Lesions of large areas can first be treated by cellular grafting, followed by tissue grafting for smaller remaining areas. 145…”

Section: Discussionmentioning

confidence: 99%

“…Because complete repigmentation is rarely achieved after 1 session, multiple sessions are necessary to improve treatment outcome and patient satisfaction. Lesions of large areas can first be treated by cellular grafting, followed by tissue grafting for smaller remaining areas …”

Section: Discussionmentioning

confidence: 99%

Surgical Interventions for Patients With Vitiligo

Bae

Lee

et al. 2021

JAMA Dermatol

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“…The ability of KPV-Lipo to alleviate vitiligo was investigated using a H 2 O 2 -induced vitiligo mouse model. 54,55 After vitiligo modeling, Lipo, KPV-Lipo, PDA, MPS, PDA+MPS, Lipo(PDA +MPS) and KPV-Lipo(PDA+MPS) in ointments at a dose of 0.08 g/cm 2 were locally applied at the lesion twice a day, followed by pathological and dermatoscopy examination (Figure 5a). As shown in Figure 5b, the skin was powdery and white after exposure to H 2 O 2 , and the melanosomes in the hair follicle had almost disappeared.…”

Section: Resultsmentioning

confidence: 99%

Biomimetic Melanosomes Promote Orientation-Selective Delivery and Melanocyte Pigmentation in the H₂O₂-Induced Vitiligo Mouse Model

Sun

et al. 2021

ACS Nano

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Extremely limited drug retention and depigmentation represent the greatest barriers against vitiligo treatment advancement. Here, inspired by biological melanosomes, the primary melanin transporter, we developed biomimetic melanosomes to combat reactive oxygen species (ROS)-mediated melanocyte damage and depigmentation. Briefly, methylprednisolone (MPS) and melanin-mimicking polydopamine (PDA) were encapsulated inside lysine–proline–valine (KPV)-modified deformable liposomes (KPV-Lipos). Owing to their phospholipid bilayer flexibility and the specific affinity for melanocortin 1 receptor (MC1R), KPV-Lipos exhibited 1.43-fold greater skin deposition than traditional liposomes. The binding of KPV and its receptor also contributed to activating the cAMP–tyrosinase (TYR) signaling pathway, improving the endogenous melanin content. In addition, PDA mimicked melanosomes as it effectively increased the exogenous melanin content and scavenged ROS. Meanwhile, MPS inhibited inflammatory cytokine secretion, limiting the depigmented area. Ultimately, the biomimetic melanosomes affected the skin color of mice with H2O2-induced vitiligo. These melanosomes show potential as a universal platform for the self-supply of melanin by self-driven melanin synthesis with exogenous supplementation. Furthermore, this study offers ideas for the production of artificial packed melanosome substitutes for melanocyte-related diseases.

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“…The combination of HFCS and NCES has been identified to achieve better re-pigmentation ( 41 ). Meanwhile, If the final effect of cellular grafting has a little deficiency, MPG can be an adjuvant and supplement therapy ( 77 ).…”

Section: Surgical Interventionmentioning

confidence: 99%

Management of the refractory vitiligo patient: current therapeutic strategies and future options

Wang,

Wu,

Chen

et al. 2024

Front. Immunol.

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Vitiligo is an autoimmune disease that leads to disfiguring depigmented lesions of skin and mucosa. Although effective treatments are available for vitiligo, there are still some patients with poor responses to conventional treatment. Refractory vitiligo lesions are mostly located on exposed sites such as acral sites and lips, leading to significant life stress. Understanding the causes of refractory vitiligo and developing targeted treatments are essential to enhance vitiligo outcomes. In this review, we summarized recent treatment approaches and some potential methods for refractory vitiligo. Janus kinase inhibitors have shown efficacy in refractory vitiligo. A variety of surgical interventions and fractional carbon dioxide laser have been widely applied to combination therapies. Furthermore, melanocyte regeneration and activation therapies are potentially effective strategies. Patients with refractory vitiligo should be referred to psychological monitoring and interventions to reduce the potential pathogenic effects of chronic stress. Finally, methods for depigmentation and camouflage may be beneficial in achieving uniform skin color and improved quality of life. Our ultimate focus is to provide alternative options for refractory vitiligo and to bring inspiration to future research.

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Micropunch grafting as an adjuvant for noncultured melanocyte-keratinocyte transplantation for refractory vitiligo

Cited by 5 publications

References 4 publications

Surgical Interventions for Patients With Vitiligo

Surgical Interventions for Patients With Vitiligo

Biomimetic Melanosomes Promote Orientation-Selective Delivery and Melanocyte Pigmentation in the H₂O₂-Induced Vitiligo Mouse Model

Management of the refractory vitiligo patient: current therapeutic strategies and future options

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Micropunch grafting as an adjuvant for noncultured melanocyte-keratinocyte transplantation for refractory vitiligo

Cited by 5 publications

References 4 publications

Surgical Interventions for Patients With Vitiligo

Surgical Interventions for Patients With Vitiligo

Biomimetic Melanosomes Promote Orientation-Selective Delivery and Melanocyte Pigmentation in the H2O2-Induced Vitiligo Mouse Model

Management of the refractory vitiligo patient: current therapeutic strategies and future options

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Biomimetic Melanosomes Promote Orientation-Selective Delivery and Melanocyte Pigmentation in the H₂O₂-Induced Vitiligo Mouse Model