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      Sustained Repigmentation in Vitiligo and Leukodermas Using Melanocyte–Keratinocyte Transplantation: 7 Years of Data

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          Abstract

          Background

          The autologous non-cultured melanocyte–keratinocyte transplantation procedure (MKTP) has emerged as an effective treatment for various types of vitiligo and leukodermas. However, there is limited data on the long-term outcomes of the MKTP, especially in Thai patients.

          Objective

          To assess the long-term efficacy and safety of the MKTP in patients with vitiligo and other leukodermas.

          Methods

          This retrospective observational study analyzed data from 23 patients who underwent the MKTP for vitiligo and other leukodermas at the Siriraj MKTP Clinic, Thailand, and had a follow-up period exceeding 12 months. Clinical characteristics and MKTP specifics were evaluated. Repigmentation outcomes were assessed using the Vitiligo Area Scoring Index (VASI).

          Results

          Of the 23 patients (24 treated lesions), 78.3% had segmental vitiligo, while the others had nevus depigmentosus, nonsegmental vitiligo, or piebaldism. Most lesions (70.8%) were located on the face. At the 12-month follow-up, repigmentation showed an 80.8% ± 19.3% VASI improvement, which was sustained over 84 months with an 80%–90% VASI improvement. There was no statistically significant difference in repigmentation outcomes between facial and non-facial lesions.

          Conclusion

          The MKTP demonstrated long-term efficacy and safety in treating vitiligo and other leukodermas, with sustained repigmentation over 84 months. These findings support the use of the MKTP as an effective treatment option for patients with refractory vitiligo and leukodermas, particularly within Thai populations.

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          Most cited references30

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          Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up.

          Vitiligo is an acquired pigmentary disorder of unknown etiology that is clinically characterized by the development of white macules related to the selective loss of melanocytes. The prevalence of the disease is around 1% in the United States and in Europe, but ranges from less than 0.1% to greater than 8% worldwide. A recorded predominance of women may reflect their greater willingness to express concern about cosmetically relevant issues. Half of all patients develop the disease before 20 years of age. Onset at an advanced age occurs but is unusual, and should raise concerns about associated diseases, such as thyroid dysfunction, rheumatoid arthritis, diabetes mellitus, and alopecia areata. Generalized vitiligo is the most common clinical presentation and often involves the face and acral regions. The course of the disease is unpredictable and the response to treatment varies. Depigmentation may be the source of severe psychological distress, diminished quality of life, and increased risk of psychiatric morbidity. Part I of this two-part series describes the clinical presentation, histopathologic findings, and various hypotheses for the pathogenesis of vitiligo based on past and current research. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
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            Autoimmune destruction of skin melanocytes by perilesional T cells from vitiligo patients.

            In vitiligo, cytotoxic T cells infiltrating the perilesional margin are suspected to be involved in the pathogenesis of the disease. However, it remains to be elucidated whether these T cells are a cause or a consequence of the depigmentation process. T cells we obtained from perilesional skin biopsies, were significantly enriched for melanocyte antigen recognition, compared with healthy skin-infiltrating T cells, and were reactive to melanocyte antigen-specific stimulation. Using a skin explant model, we were able to dissect the in situ activities of perilesional T cells in the effector phase of depigmentation. We show that these T cells could infiltrate autologous normally pigmented skin explants and efficiently kill melanocytes within this microenvironment. Interestingly, melanocyte apoptosis was accompanied by suprabasal keratinocyte apoptosis. Perilesional T cells did, however, not induce apoptosis in lesional skin, which is devoid of melanocytes, indicating the melanocyte-specific cytotoxic activity of these cells. Melanocyte killing correlated to local infiltration of perilesional T cells. Our data show that perilesional cytotoxic T cells eradicate pigment cells, the characteristic hallmark of vitiligo, thereby providing evidence of T cells being able to mediate targeted autoimmune tissue destruction.
              • Record: found
              • Abstract: found
              • Article: not found

              Guidelines for the management of vitiligo: the European Dermatology Forum consensus.

              The aetiopathogenic mechanisms of vitiligo are still poorly understood, and this has held back progress in diagnosis and treatment. Up until now, treatment guidelines have existed at national levels, but no common European viewpoint has emerged. This guideline for the treatment of segmental and nonsegmental vitiligo has been developed by the members of the Vitiligo European Task Force and other colleagues. It summarizes evidence-based and expert-based recommendations (S1 level).

                Author and article information

                Journal
                Clin Cosmet Investig Dermatol
                Clin Cosmet Investig Dermatol
                ccid
                Clinical, Cosmetic and Investigational Dermatology
                Dove
                1178-7015
                02 November 2024
                2024
                : 17
                : 2447-2457
                Affiliations
                [1 ]Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand
                Author notes
                Correspondence: Narumol Silpa-archa, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand, Tel +66 2419 4333, Email doctornarumol@gmail.com
                [*]

                These authors contributed equally to this work

                Author information
                http://orcid.org/0009-0005-8993-8023
                http://orcid.org/0009-0007-4280-1833
                http://orcid.org/0009-0008-5067-9759
                http://orcid.org/0000-0002-3161-5206
                http://orcid.org/0000-0002-9014-3229
                http://orcid.org/0000-0002-1678-5442
                Article
                485421
                10.2147/CCID.S485421
                11539787
                39507768
                0c66f076-cc8a-448a-9503-bfd80848b6dd
                © 2024 Nuntawisuttiwong et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 03 July 2024
                : 13 October 2024
                Page count
                Figures: 5, Tables: 3, References: 30, Pages: 11
                Categories
                Original Research

                Dermatology
                autologous non-cultured epidermal suspension,melanocyte–keratinocyte transplantation procedure,nevus depigmentosus,piebaldism,repigmentation,vitiligo

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