ABSTRACT
Objective: determine the efficacy and safety of the non-cultured melanocyte-keratinocyte transplantation procedure in the treatment of stable resistant generalized vitiligo. Design: A simpler and modified method based on that of Olsson and Juhlin [1998] was performed this method uses a shaved biopsy skin sample one tenth the size of the recipient area. The skin sample is incubated, and the cells are mechanically separated using trypsin-EDTA solution and then centrifuged to prepare a suspension. Cell suspension is then applied to the derma braded depigmented skin area, and a collagen dressing is applied to keep it in place
Patients: twenty one patients with stable generalized vitiligo of different sites and sizes were treated with NMKT and followed up for 6 months
Intervention: Autologous, non-cultured melanocyte keratinocyte cell transplantation
Main Outcome Measure: initial pigmentation was observed. Regimentation was graded as excellent with 75 to 100% pigmentation, good with 50% to 74% fair with 25 to 49%, and poor with <25% pigmentation, assessment by modified vitiligo area scoring index, color match ,patient satisfaction and adverse events were assessed
Results: 9.66% showed excellent response, 11.50 % showed good response, 40.38% showed fair response and 38.46 % with poor response. Average percent change in VASI was 24.56% +-33.71. The color matching was excellent to good in 65.4% and poor in 34.6% of lesions, 3.8% of patients only were very satisfied and complications were minimal. Limitations: Limitations include small sample size, lack of control group and short follow-up period
Conclusions: NMKT is an easy economic technique, which may be used in resistant areas of stable vitiligo. The smaller the size of the lesion and the longer the stability duration the higher the percentage of regimentation response obtained. Results tend to be better over the trunk and proximal limbs than elbows, knees and distal extremities. Complications are minimal the most common is post inflammatory hyperpigmentation of the donor area
ABSTRACT
The histopathologic changes characteristic of psoriasis might be related to suppressed apoptosis. P53 and Bcl-2 proteins play a central role in the regulation of apoptaosis. Skin biopsies were obtained from non-lesional and lesional skin of 10 patients with generalized plaque psoriasis before and after treatment with topical calcipotriol ointment. P53 and Bcl-2 expression was evaluated using immunoperoxidase technique and apoptotic cells by TUNEL method After topical calcipotriol therapy, keratinocytes of psoriatic skin showed significant decrease of P53 [P=0.002] and increase of Bcl-2 [P=0.01] expression. On the other hand lymphocytes showed significant decrease of Bcl-2 [P=0.01]. There were no apoptotic cells before treatment but after calcipotriol therapy, apoptosis was more detected in keratinocytes than in lymphocytes. The results of the present study suggest that one of the actions of calcipotriol in psoriasis might be exerted through induction of apoptosis especially of keratinocytes through a P53 independent- pathway. Meanwhile, suppression of Bcl-2 expression in lymphocytes may promote apoptosis of dermal lymphocytes leading to healing of psoriasis