12/4/2013

1

Update on Surgical Treatment (MT) in Vitiligo

Sanjeev V Mulekar, MD National Center for Vitiligo & Psoriasis

Riyadh, Saudi Arabia

Indications

• Clinically stable vitiligo > 1 year

• Segmental and Focal vitiligo

• Lesions with leucotrikia

12/4/2013

2

MKTP

• A day care procedure

• Average duration 2 hours

• Uses Non-cultured M - K suspension

• Absolute immobilization not necessary

MKTP

• Local – 1% Lidocaine without Adrenaline

• General – Propaphol, Ketamine, Pentothal supplemented with lidocaine

12/4/2013

3

Shave biopsy & Cell suspension

Derm-abrasion, Seeding Cell Suspension & Final dressing

12/4/2013

4

MKTP Follow-up

• Dressing removal: 1 week

• Appears red

• Re-pigmentation: 4 – 8 weeks

• Progress: 6 months

• No routine phototherapy post MKTP

MKTP - Advantages

• Duration 1 ½ to 2 hours

• Patient discharged immediately

• Absolute immobilization not required

• Dressing removal – 7 days

• Max. area treated - 300 cm2

• Same area retreated easily

12/4/2013

5

MKTP - Advantages

• Any anatomical site treated

• Donor : Recipient = 1 : 10

• No / Minimal scarring

• Good color matching

• Serum free medium

• No additives

Non-cultured MKTP

Mulekar SV. Long-term Follow-up Study of Segmental and Focal Vitiligo Treated by Autologous, Noncultured Melanocyte-Keratinocyte Cell Transplantation Arch Dermatol. 2004;140:1211-1215

12/4/2013

6

Non-cultured MKTP

Mulekar SV. Long-term follow-up study of 142 patients with vitiligo vulgaris treated by autologous, non-cultured melanocyte–keratinocyte cell transplantation Int J Dermatol 2005;44:841-45

Non-cultured MKTP

Mulekar SV , Al Issa A, Al Eisa A, Asaad M. Genital vitiligo treated by MT. Dermatol Surg 2005;31:1737-40

12/4/2013

7

Non-cultured MKTP

Mulekar SV, Al Issa A, Al Eisa A. Difficult to treat sites. Dermatol Surg 2009;35:66-71

Non-cultured MKTP

National Center for Vitiligo & Psoriasis, Riyadh

12/4/2013

8

Non-cultured MKTP

Mulekar SV, Al Issa A, Al Eisa A. Difficult to treat sites. Dermatol Surg 2009;35:66-71

Non-cultured MKTP

Mulekar SV , Al Issa A, Al Eisa A. Treatment of post-burn leucoderma with non-cultured MKTP. Burns 2011;37:448-452.

12/4/2013

9

Non-cultured MKTP

Mulekar SV , Al Issa A, Al Eisa A. Treatment of post-burn leucoderma with non-cultured MKTP. Burns 2011;37:448-452.

Nevus depigmentosus

Mulekar SV , Al Issa A, Al Eisa A. Nevus Depigmentosus treated by MKTP. J Cutan Aesthet Surg 2011;4:29-32.

12/4/2013

10

Adverse Events-Donor Site

Adverse Events

12/4/2013

11

Adverse events-Recipient Site

Adverse Events - Rare

• Scarring

• Infection

12/4/2013

12

Modifications

• Cold trypsinization

• Non-cultured extracted hair follicle outer root sheath cell suspension (NCORSHFS)

• NCORSHFS + MT

Conclusion

• Autologous Non-Cultured Melanocyte-Keratinocyte Transplantation can be an effective treatment for stable vitiligo

• NCORSHFS and MT are safe & effective with comparable efficacy (Davinder Prasad et al)

12/4/2013

13

Thank You