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Lighter colored (hypopigmented) areas of skin can be due to skin damage with scarring or for unknown reasons. When the cause is unknown the process is called vitiligo and is presumed to be due to an autoimmune phenomenon or a viral infection. Vitiligo affects 1 to 2% of the people in the world, 2 to 5 million in the US alone. Have of these affected people developed it before the age of 20. Regardless of the cause the common factor between all of them is white patches of skin where the skin pigment cells called melanocytes have been killed. If the line width of the area is in the order of a few millimeters application of a tattoo needle without tattoo pigment or application of an excimer laser has corrected the problem. Tattoos have also been employed but this is impractical when the hypopigmented patches are large. Tattooing a skin color into the white patch has not been reliable as the approximation of any given individuals native skin color is very difficult. Of course cover make up has been around for centuries and can provide adequate camouflage but has to be repeatedly applied.
With modern scientific knowledge and technical know how these larger hypopigmented areas can be effectively treated. The process involves harvesting skin from one area as with a very thin skin graft. Pulverizing that skin into a thin paste and then spraying it onto the hypopigmented area after the area has been dermabraded to create a raw surface. The process is much easier to perform using the Recell device depicted in this video.
In these cases the depigmented areas were repopulated with pigment cells.
This cell spray methodology can clearly increase or decrease skin pigmentation in the appropriate patient but the evenness and intensity of the resulting re-pigmentation is not predictable. For larger areas more than one treatment session may be required. The treatment may also be limited in Afro-Americans or others who are prone to keloid or bad scar formation. In such cases it would be prudent to first test patch a small patch of skin with dermabrasion or laser abrasion to make sure the patient does not form bad scars after the procedure.
The CelluTome device is FDA approved for epidermal (surface skin cell) harvesting. The device uses heat and suction to create an array of 128 superficial pigment containing epidermal blisters, each around 2 mm wide, over 30 minutes. It then cuts the blisters in a painless fashion without bleeding because the blisters are so superficial. The device simultaneously places all of the blister grafts on a standard surgical dressing. The donor area which is usually the thigh heals within 3 or 4 days and the same site can be used 2 or 3 times.
In treating vitiligo the depigmented area is abraded or lasered to create a raw surface that the dressing containing blister grafts is placed on. The dressing is clear so you can see graft take and repigmentation taking place. This method has been used effectively to treat vitiligo, diabetic foot wounds, burns, pyoderma gangrenosum and traumatic wounds. Most wounds heal from the edges inward but seeding the wounds in this manner speeds up the healing process as healing occurs from the edges of the wound and the edge of each blister graft.
The main problems with this approach for vitiligo is some areas such as the lips, eyelids and fingers are not amenable to placement of the clear dressing. Use on the neck or wrists would require the use of a cervical collar or splint in order to keep the dressing in place.
July 5, 2011 addendum:
A just released report describes the use of topical bimatoprost 0.03% ophthalmic solution (a prostaglandin F2-alpha analogue) in the treatment of vitiligo. 1 drop is applied per 2 cm2 of affected skin twice daily for 4 months. Repigmentation begins after 2 months of application and more than half of patients get the majority of the area repigmented. Vitiligo less than 6 mohnths old responds better than older patches of vitiligo. Facial areas respond more quickly (generally within 4 to 6 weeks) with less risk of recurrence after the 4 month treatment period than other areas of the body. This may end up being a cheaper alternative to surgery.
Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter