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Liliana Guerra, MD; Sergio Capurro, MD; Francesco Melchi, MD; Grazia Primavera, MD; Sergio Bondanza, BSc; Ranieri Cancedda, MD; Antonio Luci, MD; Michele De Luca, MD; Graziella Pellegrini, PhD

Arch Dermatol. 2000;136:1380-1389.

Objective  To optimize melanocyte/keratinocyte co-cultivation and to evaluate the effectiveness of autologous cultured epidermal grafts in the surgical treatment of stable vitiligo.

Design  After optimization of melanocyte/keratinocyte cultures, achromic lesions were disepithelialized by means of programmed diathermosurgery (Timedsurgery) and covered with autologous epidermal grafts prepared from secondary cultures. Melanocyte content was evaluated by dopa reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system.

Setting  A biosafety level 3 cell culture facility and a dermatological department in a hospital.

Patients  Thirty-two patients carrying different types of vitiligo were admitted to the study and treated with autologous cultured epidermal grafts. Inclusion criteria were (1) failure of at least 2 standard medical approaches; (2) no therapy for at least 12 months; (3) absence of progression of old lesions, absence of appearance of new lesions, and absence of Koebner phenomenon within the past 18 months; and (4) absence of autoimmune disorders.

Results  One hundred five achromic lesions (a total of 6078.2 cm²) were treated. The average percentage of repigmentation, evaluated after 12 to 36 months of follow-up, was 77%. Independent of the type of vitiligo, average percentages of repigmentation of extremities and periorificial sites were 8% (31.8 cm² repigmented/420.5 cm² transplanted) and 35% (17.6 cm² repigmented/50.0 cm² transplanted), respectively. Percentages of repigmentation of all other body sites ranged from 88% to 96% (4329.7 cm² repigmented/4675.2 cm² transplanted). Color matching was good and scar formation was not observed.

Conclusion  Cultured epidermal grafts can be considered a real therapeutic surgical alternative for "stable" but not lip-tip vitiligo.

From the Laboratory of Tissue Engineering (Drs Guerra, De Luca, and Pellegrini and Mr Bondanza), Second Division of Dermatology (Dr Melchi), Fifth Division of Dermatology (Dr Primavera), and Division of Dermatological Surgery (Dr Luci), Istituto Dermopatico dell'Immacolata, Rome, Italy; and Department of Plastic Surgery, San Martino Hospital, (Dr Capurro), and Centro di Biotecnologie Avanzate/Istituto Nazionale per la Ricerca sul Cancro and Dipartimento di Oncologia, Biologia e Genetica, Università di Genova (Dr Cancedda), Genoa, Italy.

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