Dermal autografts for stable vitiligo may yield long-term benefits

מתוך medicontext.co.il

STOCKHOLM (Reuters Health) – The results of the first long-term study of autologous melanocyte transplantation for pigment disorders, such as vitiligo and piebaldism, show that the treatment benefits are sustained for some patients, a Swedish researcher said on Monday.

Current treatments for pigment disorders, including steroid creams and PUVA (Psoralen and UV A light), can slow disease progression but do not produce a cure. Dr. Mats J. Olsson, from the University of Uppsala in Sweden, is one of several researchers who are evaluating the usefulness of transplanting melanocyte cells from pigmented areas of skin to affected patches in patients with vitiligo.

Dr. Olsson's study included 132 patients treated with one or more of three transplantation methods on a total of 176 occasions between 1993 and 1999. Patients were treated with one of three transplant modalities: suspension of basal epidermal cells from a shave biopsy; an enriched expansion melanocytes cultured under serum-free conditions; or ultrathin epidermal sheet grafts.

This study was conducted to identify patients who may benefit from transplantation and to identify the types of skin disorders and skin locations suitable for a particular method, Dr. Olsson told Reuters Health.

Patients with piebaldism and a stable pigmentation form of segmental vitiligo almost always responded with 100% repigmentation regardless of the transplantation method used, the researcher said.

Patients with a small total area of stable or spontaneously increasing vitiligo vulgaris and shorter disease duration also responded well to treatment. This group represents approximately 10% to 20% of all vitiligo vulgaris patients, Dr. Olsson added.

Autografts are not recommended for patients with extensive or unstable vitiligo, he said.

"The culturing method can cover the largest areas, but [it] is the most difficult and expensive method," Dr. Olsson said. "For several small spots, the suspension method is best. And for large single spots in non-moving locations, such as the trunk or upper arm, the ultrathin epidermal sheets method is preferable."

A spokeswoman for Britain's Vitiligo Society told Reuters Health that the benefits of the autografting techniques are limited because the majority of vitiligo patients do not have a stable form of the disease.

Dr. Aaron B. Lerner, professor emeritus and former chairman of the department of dermatology at Yale University, applauded the Swedish work. "Mats Olsson has done a very good piece of work in putting together the use of pigment cell transplantation as a basic treatment for vitiligo," he told Reuters Health.

Dr. Olsson plans to publish his results later this year. Preliminary study results were published in The Lancet and the British Journal of Dermatology.

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