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Cellular transplantation procedures in vitiligo: what is in
We read with great interest the recently published review by
Vakharia et al.
on the efﬁcacy and safety of noncultured melano-
cyte-keratinocyte transplantation procedures (MKTP) in vitiligo.
The timing of the literature is apt considering the increasing inter-
est in this procedure among dermatologists. However, we feel
that the review performed was not adequate. It appears that the
search terms used for literature search in the review, “me-
lanocyte-keratinocyte transplantation” or “autologous noncultured
cellular grafting,” left behind many good quality clinical trials that
described the procedure as “autologous non-cultured epidermal
cell suspension (NCES),” “autologous noncultured basal cell-
enriched epidermal cell suspension,” or simply, “epidermal cell
suspension (ECS).” The authors quoted only two clinical trials of
small sample sizes (n = 10 and n = 8) in the review and reported
more case studies. Hence, the authors erroneously concluded
that there was a paucity of good quality evidence to draw solid
conclusions on the efﬁcacy and safety of the procedure. We
would like to append the review with some important clinical trials
published between 2001 and 2017 (Table 1). It should be noted
that many of these studies were quoted even in the recent
Cochrane review on interventions for vitiligo.
We have not
included case studies and clinical trials with small sample sizes
considering the plethora of literature that denotes the procedure
of MKTP as NCES or ECS.
The hair follicle is an important source of melanocytes and vari-
ous stem cells. However, while deﬁning cellular transplantation
methods, the authors only mentioned skin as the source of mela-
nocytes. Accordingly, the authors did not include noncultured
outer root sheath hair follicular cell suspension (NCORSHFS),
which is a type of noncultured melanocyte-keratinocyte transplan-
tation, in their review. The same procedure was vividly denoted
as noncultured, extracted follicular outer root sheath suspension
(NC-EHF-ORS-CS), extracted hair follicle outer root sheath cell
suspension (EHFORSCS), or simply as follicular cell suspension
An overview of clinical trials on cellular transplantation procedures in vitiligo
(% repigmentation) Complications
28 (66) 12 GV = 28 >75% RP in 77% of lesions at
ECS side compared to none in
the matched patches of placebo
Hyperpigmentation at the
recipient site (n = 5)
Sahni et al.
25 (36) 4 GV = 18
FV = 4
SV = 3
>75% RP in 78.6% of patients
Superior RP outcome when cell
suspension was suspended in
the patients’ own serum
compared to cell suspension
suspended in normal saline
Infection (n = 3), peri-graft
halo (n = 3),
hyperpigmentation at donor
site (n = 8), scarring (n = 2)
Budania et al.
41 (54) 4 GV = 15
FV = 10
SV = 16
>75% RP in 89% of the ECS
group compared to 85% in the
suction blister group
None reported 1b
Singh et al.
30 (47) 4 GV = 15
FV = 4
SV = 11
>75% RP in 92% of the ECS
group compared to 78% in the
None reported 1b
Razmi et al.
30 (84) 4 GV = 21
FV = 3
SV = 6
>75% RP in 76% of the
ECS+FCS group compared to
57% in the ECS group
Hyperpigmentation at donor
site (n = 7)
GV, generalized vitiligo; FV, focal vitiligo; SV, segmental vitiligo; RP, repigmentation; ECS, epidermal cell suspension; FCS,
follicular cell suspension; ECS+FCS, combination of ECS and FCS.
International Journal of Dermatology 2018, 57, e30–e43 ª 2018 The International Society of Dermatology