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Vitiligo is a skin disease characterized by milky white patches on the skin. Though it is a relatively innocuous condition, it can cause a significant amount of disfigurement on pigmented skin and the psychological morbidity it can cause is tremendous. Vitiligo is just one of the causes for loss of skin pigmentation or leukoderma. Other skin diseases causing inflammation and chemical or physical damage to skin can also lead to loss of pigmentation.
Vitiligo is characterized by the loss of cells giving colour to the skin (melanocytes) often due to an autoimmune process. There are various medical and surgical modalities of treatment for vitiligo. However the response to treatment depends on various factors like type of vitiligo, site of involvement and patient compliance.
Surgical modalities of treatment are employed for patches which do not respond to medical treatment. It can be successfully used only for stable patches which do not increase in size and number for at least 2 years. These types of patches are usually seen over the lips and finger tips. Conventional surgical treatments include skin grafting in various forms like punch grafting, blister grafting and split thickness skin graft. The mature melanocytes in the grafted skin will migrate to the diseased area thereby rectifying the defect. However since there is no amplification of the number of melanocytes, recovery takes time and is often incomplete. Uniform dispersion of pigment, important for good cosmetic results, cannot be guaranteed.
Replenishing melanocytes selectively within vitiliginous macules by the patient’s own melanocytes is a promising treatment and is in vogue since the early nineties. Moreover, with the introduction of melanocyte culture, it has now become possible to treat larger areas with smaller skin samples. This method involves culturing skin melanocytes, to generate a proliferating population of epidermal melanocytes which can be transplanted to the affected area. Till recently this was a difficult procedure performed only in few centres. However recent discovery of culture media composed of easily available ingredients have simplified the technique and the melanocytes now exhibit increased proliferating capacity, migratory behaviour and melanin production.
Melanocytes do not express HLA antigens making them less susceptible to attack by ones own immune system even if cells from a related donor are used. Cultured melanocytes may also be genetically engineered, prior to transplantation, to enable them to produce a wide range of proteins. Hence melanocytes can also be used as a gene therapy vector for a variety of genetic disorders.
Recent advances in melanocyte culture and transfer can have an impact not just on the treatment of leukoderma, but a wide range of genetic disorders as well.
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