Surgical treatments can be performed by a qualified dermatologist, who is trained adequately.
Melanocyte transplantation Also known as Non-cultured Melanocyte-Keratinocyte Transplantation Procedure (MKTP) is the latest modification in the surgical management of Vitiligo/Leukoderma. It involves separating skin cells from normal skin and transplanting on white spots as a cell suspension after removal of upper layer of skin superficially. It can be performed in 1 to 3 hours as a day care procedure.
In this treatment large affected lesions can be treated. The cosmetic results achieved are superior to other surgical methods such as skin grafting and punch grafting. Moreover, the difficult to treat areas like bony surface, areola, genitals and knuckles can also be treated with excellent results.
This brings us to the question – What are Melanocytes? Well, Melanocytes are skin cells which produce melanin. A complete absence of skin colour usually means that melanocytes have been destroyed.
Thanks to an innovative treatment it is now possible to take melanocytes from a healthy area of the skin and transfer them as cellular suspension onto the de-pigmented patches. This process can be performed in a clinic anywhere between one and three hours.
The Procedure step-by-step
- In a clean procedure room, a thin shave biopsy is taken. The most common site is anterior, upper third of thigh.
- The biopsy is processed using an enzyme to separate the layers of skin and to make a skin cell suspension. This suspension contains melanocytes-keratinocytes (epidermal cells).
- The area to be treated is abraded with diamond fraize wheel and the cell suspension is applied. It is covered with collagen sheet, which helps to keep cells in place and promotes healing.
- The final dressing consists of a micropore or tegaderm depending on sites involved.
Is one operative session enough for a complete recovery?
All patients do not achieve complete re-pigmentation in one session. Approximately 30% of patients require repeat surgery to improve the results.
Who is suitable for Melanocyte Transplantation?
Clinically stable patient: Patients who have had stable Vitiligo lesions for a period of at least 1 year are good candidates to undergo melanocyte transplantation (MKTP). Further Vitiligo patients should fulfil the following criteria to be eligible for surgery:
- Existing patches should not have increased in size
- No new patches should have appeared on other areas.
- Any injury should heal with normal skin colour.
There are three main categories of patients that are suited to melanocyte transplantation (MKTP).
- Segmental Vitiligo
- Generalized Vitiligo –Affected area < 20%
- Non-Vitiligo-Piebaldism, post-burn Leukoderma
One should note that the selection of a patient will depend upon assessment by a physician.
Who is not suitable for Melanocyte Transplantation?
Patients with fingertip/lips involvement are not suitable for melanocyte transplantation (MKTP).
Response according to type of Vitiligo:
- Segmental – most suitable; success rate 90-94% (See below)
- Focal – Success rate of approximately 80%
- Vulgaris – Success rate of approximately 65%
- Acral – Poor response in all areas. Success rate-data not available
Success rate of such a treatment is 94% (i.e. 94% of treated patients who have pigmentation in over 65% to 100% of the treated area. A statistical figure of success rate applies to a group of people and not to an individual.
Recurrence of Vitiligo after treatment:
- Segmental – Recurrence is rare.
- Focal – Low chance of recurrence. It can develop in vulgaris type.
- Vulgaris – May recur
- Acral – Very high rate of recurrence
How much area can be treated?
In one operative session up to 100 cm2 white patches can be treated depending upon the sites involved. It can be up to 250cm2 in selected patients. Multiple operative sessions are required for large areas.
- Local – injection; Lidocaine 2% or Lidocaine cream or combination
- General – used for multiple patches or if pain tolerance of the patient is low.
What happens post-treatment?
The treated site is protected by a dressing for one week. Verbal and written post treatment instructions are provided. Upon removal of dressing, the treated area appears bright red. Re-pigmentation begins in 4 to 8 weeks and continues to progress up to 4 to 6 months post-surgery. Post-operative pain depends upon the site and areas treated; feet being the most painful, and face the least.
Complications & Side Effects – are rare in expert hands.
Scarring and Koebner’s phenomenon – Trauma of surgery may cause new lesions (Koebner’s phenomenon) and is seen in approximately 2% of our patients.
Hypo-pigmented ring – This may appear on the border of treated and re-pigmented patches in some patients. Usually this ring disappears automatically or with the application of local steroids, or by repeat surgery. Rarely does it persist in spite of treatment.
Bacterial infection –All patients are given oral antibiotics to prevent infection.
Colour mismatch – There may be some instances of colour mismatch vis-à-vis surrounding areas.
Advantages of Melanocyte Transplantation
- It is a day care procedure. Patients can go home immediately if local anaesthesia is used.
- A large area can be treated in one operative session.
- A very small piece of normal skin is sufficient to treat large affected area, e.g. 10 cm2of donor skin is enough to treat 100 cm2 of Vitiligo/Leukoderma patches.
- Yields very good cosmetic results.
- It has very minimal or no side effects.
- Postoperative treatment depends upon the response.
Important Note: It is important to note that since no cause is known, there is no permanent cure for Vitiligo/Leukoderma. The disease can be treated to achieve re-pigmentation of Vitiligo patches, but it cannot be cured from the root.