In
vitiligo and
piebaldism the lack of
melanin in the epidermis is due to the fact that melanocytes are missing. The patients suffer psychologically and the white areas have lost the part of the skin barrier protection normally provided by the melanocytes. Medical treatments are ineffective in many of the patients, and surgical methods have therefore been developed.
OBJECTIVES: It is important to investigate the long-term results and factors that might influence the outcome of melanocyte
transplantations in order to form a basis for guidance in the selection of patients who will benefit most from the treatments.
METHODS: A follow-up of 132 patients who had been treated by
transplantation on 176 occasions in total, 1-7 years previously, was carried out by questionnaires and clinical examinations. We investigated the responses in five types of leucoderma to three different
transplantation methods: autologous cultured melanocytes, ultrathin epidermal sheets and basal layer cell
suspension.
RESULTS: Stable types of leucoderma, i.e. segmental
vitiligo and
piebaldism, responded in most cases with 100% repigmentation, regardless of the surgical method used. For these types of leucoderma surgery seems to be the method of choice. The largest group,
vitiligo vulgaris, was thoroughly scrutinized and three statistical models were used to analyse the data. The ultrathin epidermal sheet method gave somewhat better overall results, but was the method that gave the worst outcome in knee and elbow areas, emphasizing the importance of the right choice of method depending on the anatomical location to be treated. Irrespective of the method, fingers and elbows were the most difficult areas to repigment. The trunk and the arms and legs (not including elbows and knees) responded best. Patients with increasing and/or extensive
vitiligo vulgaris more often showed incomplete repigmentation. They also had a lower chance of retaining their repigmentation compared with those with less extensive
vitiligo. Patients in whom untreated white lesions had increased in recent years tended to respond less well to
transplantation compared with patients with unchanged or decreased lesions. Within the
vitiligo vulgaris group, patients with short disease duration or with small total
vitiligo area responded best to
transplantation. The subgroup of
vitiligo vulgaris patients with
hypothyroidism tend to respond less well to the
transplantation and they were generally older at
vitiligo onset. This information is of great importance for the selection of patients and when informing about the chances of improvement after
transplantation. Slight
hyperpigmentation was common, especially when ultrathin epidermal sheets had been used. No
scars or indurations were seen in treated areas.
CONCLUSIONS: