Regenerative therapy for refractory vitiligo using cultured epithelial sheet grafting

Background Vitiligo, the most common refractory, acquired skin disease, has an estimated population incidence of 0.5 ~ 1.0%. The pathogenesis of vitiligo can be classified into two major types, segmental and non-segmental (generalised), both of which, depending on the site of onset, significantly reduce the quality of life of patients and affect their social life. Autologous cultured epithelial sheet grafting reduces surgical invasion of normal skin and is excellent for large-area skin defect treatment. We investigated the efficacy of cultured epithelial grafting in patients with refractory vitiligo who failed to respond to standard vitiligo therapy. Methods In 16 patients (6 males; 10 females; average age, 33.06 [13–71] years), 21 vitiligo sites were treated, with a follow-up period of 3 months to 1 year. Vitiligo types were segmental type ( n = 2), non-segmental type ( n = 11 cases: generalised, acrofacial, and universal types, with nine, one, and one case, respectively), non-classified type ( n = 2), and Sutton’s nevus ( n = 1). Spindle-shaped skin sample was obtained near the inguinal region for epithelial cell culture. The skin was digested enzymatically to obtain free cells. The epithelial cells and melanocytes contained in the obtained free cells were cultured separately. Thereafter, the cultured melanocytes were seeded onto the cultured epithelial cells. Under local anaesthesia, the area of vitiligo was abraded, and a cultured epithelial sheet containing melanocytes was grafted onto the abraded region. After grafting, the results were evaluated using the vitiligo area scoring index (VASI) score. Results The preoperative and 3 months postoperative VASI were 4.62 + / − 0.74 and 3.43 + / − 1.03 (21 sites in 16 patients: p = 1.2 × 10 −4 ), respectively, with significant improvement. The VASI score was 2.56 + / − 1.20 (18 sites in 13 patients, p = 8.1 × 10 −7 ) at 6 months and 2.25 + / − 1.61 (16 sites in 11 patients, p = 2.5 × 10 −5 ) at 1 year. At 6 months and 1 year post grafting, the VASI significantly improved compared to that preoperatively. Conclusions The melanocyte-containing cultured epithelial sheet grafting was effective for segmental vitiligo and showed some efficacy for non-segmental (generalised) vitiligo, but no effect in unclassified or some non-segmental vitiligo types. Therefore, further clarification of the mechanisms underlying vitiligo is necessary. Our cultured epithelium-containing melanocytes may be useful for treating skin deformities caused by pigmentation and/or depigmentation. Level of Evidence: Level IV, therapeutic study.