Treatment of Vitiligo on Difficult-to-Treat Sites Using Autologous Noncultured Cellular Grafting

Because of the limitations of medical treatment, various surgical therapies have been developed and are being accepted to treat vitiligo. However, certain areas such as the fingers and toes, palms and soles, lips, eyelids, nipples and areolas, elbows and knees, and genitals are considered difficult-to-treat areas. To evaluate data pertaining to individual sites considered to be difficult to treat and highlight that noncultured melanocyte-keratinocyte transplantation (MKT) does not require any special precautions to treat these anatomical sites. Forty patients (13 male and 27 female) with bilateral vitiligo and nine (4 male and 5 female) with unilateral vitiligo were treated using noncultured MKT, for difficult-to-treat sites at the National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia, and were analyzed for response according to region. Repigmentation was graded as excellent with 95% to 100% pigmentation, good with 65% to 94%, fair with 25% to 64%, and poor with 0% to 24% of the treated area. For bilateral vitiligo, more than 50% of patients treated for difficult sites showed more than 65% repigmentation of the treated areas. For unilateral vitiligo, all of the patients except for two treated for the eyelids showed more than 65% repigmentation of the treated area. The concept of a difficult-to-treat site is a relative term and depends upon the technique used. The noncultured MKT does not require any special precautions to treat these anatomical sites. This review may help physicians to change the concept of difficult-to-treat site. The authors have indicated no significant interest with commercial supporters.