Efﬁcacy and safety of noncultured melanocyte-keratinocyte
transplant procedure for vitiligo and other leukodermas:
a critical analysis of the evidence
Paras P. Vakharia
, Dylan E. Lee
, and Amor Khachemoune
Oakland University William Beaumont
School of Medicine, Royal Oak, MI, USA,
Creighton University School of Medicine,
Omaha, NE, USA, and
Service, Veterans Affairs Hospital & SUNY
Downstate Medical Center, Brooklyn, NY,
Veterans Affairs Hospital & SUNY
800 Poly Place
Brooklyn, NY 11209
*These authors contributed equally to this
Conﬂicts of interest: None.
Vitiligo is an acquired pigmentary skin of depigmentation occurring secondary to
melanocyte destruction. Vitiligo and other leukodermas have a profound impact on quality
of life. Current therapies include medical options, such as phototherapy, topical and
systemic corticosteroids, topical calcineurin inhibitors, immunomodulators, and
antioxidiants, and surgical options. Surgical options provide melanocytic cells to previously
depigmented areas and use either tissue grafting or cellular grafting methods. Topical
treatments are often insufﬁcient, and many of the current surgical procedures have shown
variable response rates. In this review, we discuss the process of the cellular grafting
melanocyte-keratinocyte transplantation procedure (MKTP) and critically analyze its
efﬁcacy and safety in the treatment of vitiligo and other leukodermas. PubMed was
searched for studies (2001–2017) describing the use of MKTP in patients with vitiligo or
other leukodermas. Articles or trials discussing the use of MKTP for these patients were
selected for in-depth review. Clinically relevant results regarding efﬁcacy and safety of
MKTP in vitiligo and leukoderma patients were analyzed. Numerous trials and case series/
reports have demonstrated tolerability and efﬁcacy of MKTP with repigmentation for
patients with refractory, stable vitiligo. However, the response rates have been variable,
likely inﬂuenced by vitiligo type and affected areas. Future research and clinical reporting
will provide more insight on which phenotypes may beneﬁt from MKTP.
Vitiligo is an acquired pigmentary skin disease and form of leuko-
derma that presents with well circumscribed, depigmented mac-
ules and patches occurring secondary to the destruction of
Any area of the body can be affected, though
the face, upper chest, dorsal hands, axillae, and groin are most
Although the cause of this condition is
unknown, multiple theories (each of which may likely contribute)
have been proposed, including autoimmune, neurohumoral, cyto-
toxic, and oxidative stress hypotheses.
Vitiligo, which affects
approximately 0.5–1% of the population, occurs in patients of all
ages, but almost half present before 20 years of age.
women are equally affected, and there is no difference in preva-
lence with respect to skin type or race.
The psychological bur-
den of this condition and associated impact on quality of life can
be signiﬁcant, especially in those with darker skin types.
can be divided into two main forms: nonsegmental and segmen-
tal. The nonsegmental form, also referred to as vitiligo vulgaris, is
more common and often features symmetrical patches that usu-
ally increase in size over time. The segmental form has a unilat-
eral distribution that may completely or partially correspond to a
dermatome; this form often has a rapid onset followed by a stable
course and may be more amenable to treatment.
Other types of leukoderma include post-burn leukoderma,
piebaldism, chemical leukoderma, drug-induced leukoderma,
melanoma-associated leukoderma, and halo nevi.
the clinical presentation and pathogenic factors leading to these
leukodermas differ, all are similarly characterized by areas of
depigmentation occurring secondary to altered melanocyte
Current therapies for vitiligo and other leukodermas include
both medical and surgical options. Medical treatments include
phototherapy (e.g. narrow-band ultraviolet B [NBUVB] radiation),
topical and systemic corticosteroids, topical calcineurin inhibitors,
immunomodulators, and antioxidants.
Surgical options, which
are indicated for stable vitiligo refractory to medical management,
provide melanocytic cells to previously depigmented areas and
International Journal of Dermatology 2018, 57, 770–775 ª 2018 The International Society of Dermatology