Epidermal Cell Suspensions Research Articles

Conventional suspension delivery versus tattooing pen-assistedsuspension delivery in non-cultured epidermal cell suspension procedure for vitiligo: A randomized controlled trial.

Non-cultured epidermal suspension (NCES) is one of the most widely used surgical therapy for stable vitiligo patients in which recipient size preparation plays an important role in the outcome of NCES. The primary objective is to evaluate and compare the efficacy and safety of conventional suspension delivery after manual dermabrasion (CSMD) versus tattooing pen-assisted suspension delivery (TPSD) in NCES. Paired vitiligo units (VU) in 36 patients, matched with respect to size and location were divided into two groups. The VU in Group 1 underwent suspension delivery by CSMD while the VU in Group 2 underwent same by TPSD. All the VU were followed up at regular intervals until 24 weeks. At the end of 24 weeks, 31 VU (86.1%) in Group 1 achieved >75% repigmentation which was significantly higher (p = .02, chi-square test) as compared to 22 VU (61.1%) in Group 2. The color matching in both the groups VU was also comparable (p = .84, chi-square test). The patient global assessment (PGA) was significantly higher in Group 1 VU as compared to Group 2. Treatment response in terms of repigmentation and PGA was significantly better in VU treated with CSMD as compared to TPSD. Recipient site complications were seen more commonly in Group 1 VU as compared to Group 2. Perilesional halo at the recipient site was seen in none of the VU in Group 2 which was significantly lower than 6 VU in Group 1 than (p = .02, chi-square test). Better results may be possible with technical improvisations in tattooing pen needle diameter and depth of penetration.

Noncultured Trypsinized Epidermal Cell Suspension Transplantation After Cryoblebbling Versus Noncultured Nontrypsinized Epidermal Cell Graft Homogenized With Plasma Gel After Dermabrasion for Stable Vitiligo.

Vitiligo treatment is challenging, especially for resistant and stable vitiligo, which requires surgical management. Noncultured epidermal cell suspension has been modified to enhance the treatment outcomes. Comparison of autologous noncultured trypsinized epidermal cell suspension in recipient site prepared by cryoblebbling and noncultured nontrypsinized epidermal cell graft homogenized with plasma gel in recipient site prepared by dermabrasion for stable vitiligo treatment. Interventional comparative study on 30 patients with stable vitiligo, randomly divided into 2 equal groups. Group A: noncultured trypsinized epidermal cell suspension for recipient prepared by cryoblebbling. Group B: noncultured nontrypsinized epidermal cell graft homogenized with plasma gel for recipient prepared by dermabrasion. Afterward, both groups received 3 months of narrow-band ultraviolet B phototherapy. The plasma gel group showed a significantly earlier onset of repigmentation and faster healing ( p = .002* and <.001*, respectively). Overall, repigmentation was higher in the plasma gel group ( p = .037* at the end of the second month). Color matching and patient satisfaction were higher in the plasma gel group, without statistical significance. The cryobleb group showed more recipient site complications, and the plasma gel procedure was relatively easier and cheaper. Plasma gel modification is cost-effective, less time-consuming, does not require trypsinization, and provides rapid, satisfactory, and uniform repigmentation. Cryoblebbing and trypsinization are effective; however, there are more technical difficulties, delayed healing, and delayed onset of repigmentation.

Comparative outcomes of autologous cultured melanocytes transplantation and non-cultured epidermal cell suspension transplantation in piebaldism patients: A retrospective study.

To compare the efficacy and safety of autologous cultured melanocytes transplantation (CMT) and non-cultured epidermal cell suspension transplantation (NCES) in the treatment of piebaldism. A retrospective study was conducted on 30 anatomically based lesions from nine piebaldism patients who underwent either CMT (n=7) or NCES (n=23) between 2018 and 2020. The extent of repigmentation and colour matching was evaluated in all recipient sites using a digital imaging analysis system. In addition, adverse effects have also been assessed by follow-up results. More than 75% repigmentation was achieved in 100% (7/7) and 60.9% (14/23) of the 30 lesions with the CMT and NCES, respectively. There were significant differences between the two methods in terms of repigmentation. The majority of patients had colour mismatches, and there was no discernible difference between the two surgical techniques. Adverse reactions rarely occurred. The present study suggested that autologous CMT may provide better repigmentation in piebaldism patients than NCES with no significant side effects.

43769 Molecular Correlation of Re-Pigmentation brought by Non-Cultured Epidermal Cell Suspension versus Hair Follicle Cell Suspension.

43769 Molecular Correlation of Re-Pigmentation brought by Non-Cultured Epidermal Cell Suspension versus Hair Follicle Cell Suspension.

DS13 A comparative study between recipient site preparation using manual dermabrasion and tattooing pen in autologous noncultured epidermal cell suspension procedure in stable vitiligo patients: a randomized double blinded study

Abstract Vitiligo is a common acquired disorder of depigmentation that occurs as a result of melanocyte loss. Surgical therapies are indicated in patients with stable disease who fail to respond to medical therapies. This mostly includes autologous grafting techniques both tissue and cellular (both cultured and noncultured). Common techniques of recipient site preparation include dermabrasion, suction blistering, liquid nitrogen, electrofulguration and microneedling. The aim was to assess the difference in extent of repigmentation with manual dermabrasion and tattooing pen in a noncultured epidermal cell suspension on stable vitiligo patches. This was a prospective intraindividual comparative study. Thirty-six patients with stable vitiligo were recruited. Patients had a clinical diagnosis of segmental or nonsegmental vitiligo and had two independent patches of 3 × 3 cm or more present either symmetrically or unilaterally over the same body site or a single patch of 6 × 6 cm or more. Vitiligo lesions had been stable for ≥ 1 year. At week 24, the proportion of patients achieving &amp;gt; 75% repigmentation with manual dermabrasion was 86%. In contrast, 61% of patients in the tattooing pen group achieved &amp;gt; 75% repigmentation. At week 24, the proportion of patients achieving &amp;gt; 50% repigmentation with manual dermabrasion was 89% vs. 72% of patients in the tattooing pen group. Eighty per cent of patches at acral sites in patients in the manual dermabrasion group achieved &amp;gt; 75% repigmentation vs. 94% in nonacral patches, whereas in the tattooing pen group, 47% of patches at acral sites achieved &amp;gt; 75% repigmentation vs. 73.3% in nonacral patches. In terms of colour matching, at 24 weeks, good colour matching with the surrounding normal skin was obtained in 80% of patches in both groups. There was a significant difference in efficacy between the two methods in favour of manual dermabrasion. Tattooing pen for melanocyte delivery has the advantage over manual dermabrasion in that it is less time consuming and also reduces cell loss. Recipient site preparation by manual dermabrasion showed a higher rate of infection vs. the tattooing pen at 4 weeks (25% vs. 6%). Recipient site preparation in terms of colour matching and halo phenomena was comparable in both the groups, with no significant difference seen. Patient satisfaction in terms of physician global assessment score and Vitiligo Quality of Life index (VitiQoL) was comparable for both methods, with no significant difference seen.

585 Comparison of efficacy between cultured melanocyte transplantation and non-cultured epidermal cell suspension in stable vitiligo- a systematic review and meta-analysis

585 Comparison of efficacy between cultured melanocyte transplantation and non-cultured epidermal cell suspension in stable vitiligo- a systematic review and meta-analysis

A Randomized Controlled Study Comparing the Efficacy of Autologous Smashed Follicular Dermal Graft and Epidermal Cell Suspension versus Normal Saline Dressing in the Treatment of Chronic Nonhealing Trophic Ulcers in Patients with Hansen's Disease.

Trophic ulcers remain the most common reason for hospitalization in patients with Hansen's disease. With the introduction of new therapeutic regimens, leprosy can now be cured. However, complications of the disease, such as sensory loss, muscle palsy, absorption of extremities, and recurrent ulcers, still lead to substantial morbidity. The management of patients with trophic ulcers and their consequences is difficult, because it is a recurrent and recalcitrant problem. To evaluate the efficacy of autologous smashed follicular dermal graft and epidermal cell suspension (ECS) in the treatment of chronic nonhealing trophic ulcers in patients with Hansen's disease and to compare its efficacy with normal saline dressing. A total of 46 chronic nonhealing trophic ulcers were randomized into two groups (23 ulcers in each): Ulcers in Group A were treated with autologous smashed follicular dermal graft and ECS; ulcers in Group B were treated with normal saline dressings. Ulcers were assessed based on the rate of ulcer size reduction at every week till 12 weeks and then once a month till the sixth month. All 23 (100%) ulcers in Group A had healed within the study period of six months, whereas only 14 (60.9%) ulcers had healed in Group B. Nine (39.1%) ulcers in Group B had not healed even at the end of six months. All 23 (100%) ulcers in Group A had healed within eight weeks, which was statistically significant, P value <0.05. Trophic ulcers heal faster by autologous smashed follicular dermal graft and ECS, with good results of re-epithelialization of the ulcer bed than by normal saline dressing.

A Comparative Study between Autologous Noncultured Trypsinized Melanocytes-Keratinocytes Cell Suspension and Autologous Noncultured Nontrypsinized Epidermal Cells Grafting (Jodhpur Technique) in Stable Vitiligo.

Noncultured epidermal cell suspension (NCES) and Jodhpur technique (JT) are two treatment options in vitiligo, in which the basic principle is the transfer of melanocytes from uninvolved skin to stable vitiligo patch in the form of either tissue graft or cellular graft. The aim of this study was to evaluate effectiveness of two different treatment methods (NCES and JT) in stable vitiligo. This was a randomized comparative study, which included 45 patients with 153 stable vitiligo patches. Cases were randomly divided into two groups. Appropriate statistical analysis was done. A value of P < 0.05 was considered statistically significant. Of 45 cases, female-to-male ratio was 1.36:1. Mean duration of disease and stability were found to be 10.44 ± 5.24 and 3.83 ± 2.31 years, respectively. Mean size of treated area for NCES and JT was 10.11 ± 10.31 and 10.13 ± 10.29 cm2, respectively. Earliest repigmentation was found at 3 weeks in NCES and 6 weeks in JT. At 6 weeks, repigmentation was better in NCES, whereas later JT showed better pigmentation. Follow-up was done at 8 days and 6, 10, 14, and 24 weeks. With respect to color match at 6 weeks, JT was found superior; however, at 24 weeks both showed similar efficacy. Mean reduction in daily life quality index was significantly decreased post-surgery. This was a single-center, small sample size study. Melanocyte plus keratinocyte cell transfer is very effective in the treatment of stable vitiligo. On the basis of the results, JT may show significant contribution in vitiligo.

Evaluation of clinical efficacy and laboratory indicators of non-cultured epidermal cell suspension and hair follicle cell suspension in surgical management of stable vitiligo: A randomized comparative trial.

Non-cultured epidermal cell suspension (ECS) and hair follicle cell suspension (HFCS) are well-established methods of surgical treatment of stable vitiligo. The aim of the present study was to compare the laboratory indicators and clinical efficacy of ECS and HFCS in the treatment of stable vitiligo. This was a single centre, open-labeled randomized trial. Vitiligo patches from 74 patients were randomized to receive either ECS or HFCS. Both cell suspensions were analyzed for total cell count, cell viability and melanocyte count. Percentage re-pigmentation was assessed at regular intervals for 36 weeks. The percentage re-pigmentation with ECS was significantly higher than HFCS at week 4 (p=.01) and week 16 (p=.03) however, no difference was observed at weeks 24 (p=.38) and 36 (p=.05). Forty-seven patients completed the study follow-up duration and excellent re-pigmentation (>90%) was achieved in 61.7% and 53.2% and complete re-pigmentation (100%) was observed in 6.4% and 12.8% of participants using ECS and HFCS, respectively. Significantly higher cell yield (p < .01) and percentage of HMB45+ melanocytes (p=.01) were obtained using ECS. No difference was noted in the percentage of viable cells or S100 + melanocytes. The median cell yield was eight times higher in ECS than in HFCS with a significantly higher percentage of HMB45+ melanocytes in the former group. The median percentage of re-pigmentation in both groups was 90% at the end of 36 weeks. ECS provides faster re-pigmentation; however, both ECS and HFCS have comparable safety and efficacy over a longer duration of follow-up.

Synergistic Use of Novel Technological Advances in Burn Care Significantly Reduces Hospital Length of Stay Below Predicted: A Case Series

Length of stay is an important metric in healthcare systems, primarily because it reflects the cost of care provided. In the United States, as in many countries, inpatient hospital stays are significantly more expensive than outpatient care across all healthcare conditions,1 so earlier discharge and transition to outpatient care is crucial to help control the ever-increasing cost of healthcare. In burn patients, length of stay has traditionally been estimated at 1 day per 1% total body surface area of burn. This estimation was first described in a round table discussion in 1986.2 However, since that time there has been significant evolution in the quality of care available to burn patients, in both the operating room and ICU. The use of new harvesting techniques, synthetic dermal substitution, and autologous epidermal skin cell suspension are allowing large, deep burns to be excised and covered in much quicker time frames than historically were possible. Examples include the skin harvesting and wound debridement device for grafting and excision, biodegradable temporizing matrix as a fully synthetic dermal template, and regenerative epidermal suspension concerning cell harvesting. Although these modalities can all be used separately, we believe that using them in conjunction has allowed us to shorten the length of stay in patients with severe partial and full-thickness burns. We present an initial case series of three patients with anticipated hospital lengths of stay of 54.5, 55, and 51 days, who were ready for discharge in 37, 35, and 43 days, respectively.

Microneedling and 5-flurouracil can enhance the efficacy of non-cultured epidermal cell suspension transplantation for resistant acral vitiligo.

Acral vitiligo is often resistant to medical and surgical treatments. Non-cultured epidermal cell suspension (NCES) transplantation is a common surgical therapeutic modality for vitiligo. 5-Flurouracil (5-FU) in combination with microneedling has been found to be useful in treating vitiligo. To evaluate the efficacy of NCES transplantation either alone or following microneedling and topical 5-FU for resistant acral vitiligo. This study included 50 patients with resistant acral vitiligo allocated into two groups; group A received only NCES transplantation, and group B received microneedling and topical 5-FU 1-2 weeks prior to NCES transplantation. All patients were monitored for 24 weeks to evaluate the repigmentation response and the immunohistochemical expression of Human Melanoma Black-45 (HMB-45). At 24 weeks, the repigmentation response was significantly higher in the combination group than in the monotherapy group (p= 0.029). Moreover, the percentage of patients with successful repigmentation of 75% or greater was significantly higher in the combination group (84%) than in the monotherapy group (40%) (p= 0.001). Furthermore, lesional skin showed a significant increase in the number of active HMB+ melanocytes in both groups but without any significant difference between the two groups. However, the color intensity of HMB-45 immunostaining was significantly higher in the combination group compared to the monotherapy group (p= 0.012). There was no significant difference between the two groups regarding the adverse effects. The repigmentation response of resistant acral vitiligo to NCES transplantation could be enhanced by prior microneedling followed by topical 5-FU.

A Study to Compare Efficacy of Non Cultured Autologus Melanocyte Transfer Versus Punch Grafting Technique for Stable Vitiligo Patients

Background: Vitiligo is a common acquired idiopathic hypomelanosis, which is characterized by loss of melanocytes in the epidermis associated with autoimmune and hereditary causes. The various surgical modalities available are tissue grafting techniques such as punch grafts, suction blister grafts, and split-thickness grafts as well as cellular grafts such as autologous noncultured epidermal cell suspensions and cultured melanocyte suspensions. Objective: We aimed to study and compare the efficacy of noncultured melanocyte transfer technique and punch grafting technique in the management of stable vitiligo. Materials and Methods: Fifty patients of both sexes between the ages of 15 and 50 years having stable vitiligo for minimum 1 year were included in the study and divided in two groups. Group 1 was treated with autologous noncultured melanocyte-rich cell suspension and Group 2 was treated by punch grafting technique. Response to treatment was evaluated on the basis of degree of repigmentation (both subjective and objective assessment), which was carried out at monthly intervals for a period of 6 months along with clinical photographs. Results: The results were statistically analyzed using “Chi-square test” and “statistical significance” (p-value) methods. An excellent (&gt;75% repigmentation) result was obtained in 77.27% of patients by NCMT (noncultured melanocyte transfer) technique whereas good (60%–75% repigmentation) result was obtained in 78.57% of patients by punch grafting technique after 6 months. Conclusion: Noncultured melanocyte transfer is a simple and effective technique to produce uniform pigmentation in short duration and is suitable to cover large body surface areas with a cosmetically better outcome and is better than punch grafting.

Targeted delivery of a vaccine protein to Langerhans cells in the human skin via the C-type lectin receptor Langerin.

Human skin is a preferred vaccination site as it harbors multiple dendritic cell (DC) subsets, which display distinct C-type lectin receptors (CLR) that recognize pathogens. Antigens can be delivered to CLR by antibodies or ligands to boost antigen-specific immune responses. This concept has been established in mouse models but detailed insights into the functional consequences of antigen delivery to human skin DC in situ are sparse. In this study, we cloned and produced an anti-human Langerin antibody conjugated to the EBV nuclear antigen 1 (EBNA1). We confirmed specific binding of anti-Langerin-EBNA1 to Langerhans cells (LC). This novel LC-based vaccine was then compared to an existing anti-DEC-205-EBNA1 fusion protein by loading LC in epidermal cell suspensions before coculturing them with autologous T cells. After restimulation with EBNA1-peptides, we detected elevated levels of IFN-γ- and TNF-α-positive CD4+ T cells with both vaccines. When we injected the fusion proteins intradermally into human skin explants, emigrated skin DC targeted via DEC-205-induced cytokine production by T cells, whereas the Langerin-based vaccine failed to do so. In summary, we demonstrate that antibody-targeting approaches via the skin are promising vaccination strategies, however, further optimizations of vaccines are required to induce potent immune responses.

Comparison of Autologous Platelet-Rich Fibrin Matrix and Transplantation of Autologous Noncultured Epidermal Cell Suspension in the Treatment of Chronic Non Healing Ulcer: Randomized Comparative Study.

Chronic non-healing ulcer causes significant morbidity, high cost and reduced quality of life. To compare autologous platelet-rich fibrin matrix and transplantation of autologous non-cultured epidermal cell suspension in the treatment of chronic non-healing ulcers. The study was single-centre, prospective, randomised comparative study conducted in a tertiary care center in North India. Patients with chronic non-healing ulcer were included and randomly divided into two treatment groups- Group 1: Platelet-rich fibrin matrix (PRFM) procedure was done every 2 weeks with maximum three sittings and in Group 2: Transplantation of autologous noncultured epidermal cell suspension (NCES) procedure was done once. Follow-up was done every 2 weeks for 8 weeks then monthly for up to 5 months to evaluate the healing of the ulcer. The data were analysed by statistical package for social science (SPSS) trial version 22. To find out a significant difference in mean value between groups, the Chi-square test, student's t-test, and Mann-Whitney U test were used. A total of 41 patients were included in the study. Complete healing of ulcers occurred in 89.5% of the patients in the PRFM group and 93.8% of the patients in the NCES group at the end of 5 months (P = 0.33). The mean duration of complete healing in PRFM was 1.7 months and in NCES was 2.13 months (P = 0.20). Both procedures were effective, and there was no significant difference between the two procedures.

Comparison of Smash Skin Grafting and Autologous Non-cultured Epidermal Cell Suspension in Re-pigmentation of Stable Vitiligo.

Vitiligo is the most common depigmenting dermatosis causing immense psychosocial concern. When medical therapies fail to cause re-pigmentation, surgical modalities are developed to combat the same in stable vitiligo patients. Here we are comparing two such surgeries: smash skin grafting (SSG) and autologous non-cultured epidermal cell suspension (NCES). The aim of this article is to compare the efficacy of SSG and NCES in re-pigmentation of stable vitiligo and to know the feasibility of both the surgeries. It is an open, randomized, and prospective study conducted in dermatology outpatient department at a tertiary care center. Thirty patients with single stable vitiligo lesion were randomized into two groups: 15 each in Group A (SSG) and Group B (NCES). Following the surgery, excimer lamp phototherapy was initiated twice weekly. Patients were followed up till 16 weeks of surgery. Photo-documentation was done every month. Grading was performed for the response in the form of re-pigmentation as excellent (>75%), good (50-75%), fair (25-50%), and poor (<25%). The χ2 test was used to analyze statistical significance. Both the surgeries showed initial specks of re-pigmentation at 10-14 days post-surgery. Excellent response (>75% re-pigmentation) was observed in 10 (66.67%) patients in Group A and 9 (60%) patients in Group B. Both the surgeries showed equal response and uniform texture of re-pigmentation. SSG is equally effective when compared with NCES, in causing re-pigmentation. Also, SSG is simple, easy to perform, faster learning curve, less time-consuming, and cost-effective when compared with NCES.

Non-cultured epidermal cells suspended in either platelet-rich plasma or ringer lactate for stable vitiligo: A prospective comparative study.

Noncultured epidermal cell suspension (NCES) transplantation is a commonly used surgical treatment for resistant stable vitiligo. The combination of platelet-rich plasma (PRP) with different therapeutic modalities for vitiligo yielded higher repigmentation response, probably due to platelet-derived growth factors. To evaluate the efficacy of PRP-suspended NCES compared to NCES suspended in Ringer's lactate (RL) solution in the treatment of stable vitiligo. A prospective comparative study was conducted on 40 patients with stable vitiligo. They were divided into two equal groups: group A (treated with RL-suspended NCES) and group B (treated with PRP-suspended NCES). All patients were followed-up for 6months for assessment of their therapeutic response regarding clinical outcomes and immunohistochemical expression of HMB-45 in lesional skin. Patients treated with PRP-suspended NCES showed a significantly higher repigmentation response compared to those treated with RL-suspended NCES at 1, 3, and 6months after treatment (p=0.015, 0.023, 0.029, respectively). The expression of HMB-45significantly increased in both groups after therapy, but without a significant difference between the two groups. The repigmentation response of NCES can be enhanced by suspending the melanocytes in autologous PRP.

Dermatoscopic assessment of treatment response in patients undergoing autologous non-cultured epidermal cell suspension for the treatment of stable vitiligo: A prospective study.

There is lack of literature on serial dermatoscopic assessment in patients undergoing non-cultured epidermal cell suspension (NCES) for treatment of stable vitiligo. This prospective study was conducted to evaluate the role of serial dermatoscopy in assessing disease stability and predicting repigmentation rates in vitiligo patients undergoing NCES. Dermatoscopic assessment of target lesions were done at baseline and post-NCES at week 4, 8, 12, 16, and 24. Patches obtaining >90% repigmentation at 24 weeks were categorized to have obtained excellent repigmentation. The dermatoscopic features of target lesions that showed clinical signs of disease activity anytime during the follow-up period were compared to those maintaining clinical stability throughout. Twenty-six vitiligo patients with 52 patches, clinically stable for atleast 1year were recruited. At follow-up, six patches showed clinical signs of instability. Five patches in the unstable group developed satellite lesions by week 16, compared to none in the stable group (p <0.05). Excellent repigmentation was achieved in 29 out of 52 patches. Appearance of normal reticular pigment network at 8 weeks was a positive predictor of excellent response (OR=10.5, CI 1.2-89.7), whereas, altered pigment network at 12, 16, and 24 weeks and telangiectasias at 12 and 16 weeks significantly reduced the odds of excellent repigmentation.

Fractional versus full ablative CO2 laser in recipient site of non-cultured melanocytes and keratinocyte transplantation in treatment of vitiligo.

Melanocyte-keratinocyte transplant procedure (MKTP) or non-cultured epidermal cell suspension transplantation is a very popular surgical modality for treating stable vitiligo. The recipient-site preparation is one potential determinant in the repigmentation outcomes. To assess the efficacy of fractional CO2 (FCO2 ) laser in recipient-site preparation before MKTP and comparing it to the frequently used full surface laser ablation. This randomized comparative trial included 19 patients with 40 stable vitiligo lesions. In each patient, the treated sites were randomly categorized into two groups according to the recipient-site ablation (either fractional or full ablative CO2 laser). Assessment of repigmentation was performed six months after the procedure. Both modalities achieved successful repigmentation of a median of 80% and 77.5% for fractional and full ablation groups, respectively, with a non-statistically significant difference between them. The median of VASI change percent was -73% and -71% with fractional and full surface ablation, respectively. FCO2 laser ablation is effective for recipient-site preparation before cell suspension transplantation as well as the full ablative CO2 laser.

Electrofulguration-assisted dermabrasion is comparable to manual dermabrasion in patients undergoing autologous non-cultured epidermal cell suspension for treatment of stable vitiligo: A randomized controlled trial.

Recipient site preparation is a crucial step in non-cultured epidermal cell suspension (NCES) as it facilitates proper uptake of the grafted melanocytes. To compare the repigmentation rate of recipient sites prepared with manual dermabrasion (MD) versus electrofulguration-assisted dermabrasion (EF) in patients undergoing NCES for treatment of stable vitiligo. This was a prospective randomized study including 26 patients of stable vitiligo (VIDA 0 or -1), each having two patches of size greater than 3×3cm located symmetrically or at the same site or a single patch of 6×6cm or larger. After randomization of patches in the given patient, MD and EF were performed on recipient areas followed by NCES. The patients were followed up at 4weekly intervals up to 24weeks and assessed for extent of repigmentation and adverse effects if any. Greater than 75% repigmentation was observed in 69.3% of the patches prepared by MD as compared to 73.1% patches prepared by EF at the end of 24weeks (p=0.791). The mean improvement in target VASI was 64.0% in the MD group as compared to 68.8% in the EF group (p=0.21). Patches prepared by EF achieved successful repigmentation earlier as compared to patches prepared by MD (9.4weeks vs 11.4weeks, p=0.12). Both MD and EF have comparable outcomes with respect to all parameters.

Platelet-rich plasma in interventional dermatology and trichology: How far have we come?

Platelet-rich plasma (PRP) contains several growth factors and cellular adhesion molecules which promote wound healing, angiogenesis and accelerate the rejuvenation of skin and hair follicles. With its proven regenerative and regrowth potential in a plethora of conditions, PRP has been deemed as the “futuristic elixir.” Current evidence suggests that PRP effectively stimulates angiogenesis, collagen as well as elastin regeneration, and is a safe, easy to prepare, minimally invasive technique with limited downtime, and negligible risk of allergic/hypersensitivity reactions owing to its autologous nature. It has shown excellent results when utilized as monotherapy or in combination with microneedling or ablative lasers in acne scars, post-burn or post-traumatic scars, melasma, striae distensae, chronic ulcers, and lichen sclerosus. PRP injections or PRP combined with microneedling are increasingly being utilized for skin rejuvenation and recently have been utilized to provide non-invasive face lifts. A novel technique combining non-cultured epidermal cell suspension suspended in PRP results in superior repigmentation outcomes in case of vitiligo. Use of PRP alone or in combination with hair transplant in androgenetic alopecia is another well-researched indication and its use has been successfully extrapolated to indications such as alopecia areata, chronic telogen effluvium, and cicatricial alopecia. In spite of its established efficacy in such a vast number of indications, PRP should be used with utmost caution. These growth mediators exert their own endocrine, paracrine, and enzymatic effects, the complete influence of which still remains a mystery and only years of experience, in the times to come will unravel the absolute power of our “mighty dragon warrior.”