Vitiligo. Loss of melanocytes

Lately, there is an increasing number of publications about the surgical treatment of vitiligo, using autologous skin grafts or selective melanocyte cultures.

This new technique consists of transplanting the patient's own epidermal cells (skin cells) from a pigmented area to certain areas that appear depigmented.

In general, this cell therapy technique has been applied in those areas where a more satisfactory response is expected, such as the facial region, which is also the one that most often interests the affected people. There are other areas of the body where repigmentation is not so good, such as the hands, where the appearance of vitiligo is also frequent.

The best indication is the treatment of selective areas, not large areas, which remain stable and have not responded to conventional medical treatments.

It is important to note that surgical treatment by epidermal cell slides should never be a first choice treatment for vitiligo and should never be applied in an active vitiligo.

Finally, in those patients where the areas of vitiligo are larger than those of normal pigmented skin, the treatment may consist of depigmentation of the healthy skin by means of topical hydroquinone at high concentrations.

Cell therapy for the treatment of vitiligo is a technique that starts with the culture of epidermal cells, a mixture of keratinocytes and melanocytes, and then proceeds to selective cultures, so that they constitute a monolayer on the amniotic membrane support.

The procedure developed by a team of specialists of the Clinic, begins with the obtaining of a biopsy (small surface of skin) extracted from a hidden zone, as it can be the lumbar region or the buttock, that is pigmented.

The skin sample is then processed in the Cellular Therapy area. There, in an enzymatic way, they separate the epidermis from the dermis to obtain, from the already disintegrated epidermis, the cells necessary for the culture.

The obtained cell units are then cultivated on amniotic membrane until the growth of millions of cells is achieved.

The quantities of epidermal cells obtained from the culture should be processed until sufficient cell surface is obtained to cover the affected area. If the area to be treated is very large, the number of weeks that the epidermal cells must remain in culture will need to be increased. In this way, as many cell plates as required by the affected area are obtained.

The application of the amniotic membranes with the epidermal cells in the patient is performed in the operating room:

• First, the white spots are treated with a CO2 laser. It is necessary to apply the laser in a very superficial way to get rid of the epidermis.
• The amniotic membranes with the epidermal cells are then implanted on this epidermis.
• Once transplanted, the melanocyte layers must be covered by an occlusive dressing that will be removed after 3 or 4 days.
• Next, the patient must be exposed to solar ultraviolet radiation, if it is a suitable time of year, or UVA rays, following a certain protocol.

The surgical technique is ambulatory and is performed under local anesthesia.

In general, this cell therapy technique has been applied in those areas where a more satisfactory response is expected, such as the facial region, which is also the one that most often interests the affected people. There are other areas of the body where repigmentation is not so good, such as the hands, where the appearance of vitiligo is also frequent.