The combined use of epidermal cell suspension (ECS) and follicular cell suspension (FCS) in patients with difficult-to-treat vitiligo is associated with good to excellent repigmentation within a short time with good color match, according to the results of a recent prospective, observer-blinded, active-controlled, randomized clinical trial conducted at a tertiary care hospital in India and published in JAMA Dermatology.

The investigators sought to examine the efficacy of transplanting a combination of autologous noncultured ECS plus FCS compared with the use of ECS alone in patients with stable vitiligo.

A total of 84 matched bilaterally symmetrical patches or multiple vitiligo patches in the same anatomic region were obtained from 30 participants, who were recruited for the study between October 18, 2013 and October 28, 2016. All of the patients’ lesions had been resistant to medical modalities, with lesional stability of ≥1 year. Mean patient age was 23.4±6.4.

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Matched vitiligo patches, according to anatomic location, were randomly assigned to one of two treatment groups: group A: ECS + FCS or group B: ECS alone. Following manual dermabrasion, ECS was applied to 1 lesion and ECS + FCS was applied to the paired lesion in the same patient. All patients were followed up at 4, 8, and 16 weeks by a blinded observer, who noted the extent of repigmentation, color match, pattern of repigmentation, patient satisfaction, and any complications. Assessment of outcomes was performed with both visual and computerized image analysis methods.

Overall, 74% (62 of 84) of the lesions were considered difficult-to-treat vitiligo. The use of ECS + FCS was associated with the following statistically significant superior repigmentation outcomes compared with the use of ECS alone: extent (76% vs 57%, respectively; P <.001), rapidity (48% vs 31%, respectively; P =.001), color match (73% vs 61%, respectively; P <.001), and patient satisfaction (mean patient global assessment scores, 23.30±6.89 vs 20.81±6.6, respectively; P =.043).

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Melanocyte stem cell counts (2% in the ECS + FCS arm vs 0.5% in the ECS-alone arm), as well as expression of basic fibroblast growth factor (11.8-fold) and stem cell factor (6.0-fold), were significantly higher with ECS + FCS compared with ECS alone (P <.05 for both).

The investigators concluded that this novel treatment approach can be used in clinical practice for attaining optimal repigmentation in patients with difficult-to-treat vitiligo, as well as in situations that call for more rapid repigmentation outcomes.


Razmi T M, Kumar R, Rani S, Kumaran SM, Tanwar S, Parsad D. Combination of follicular and epidermal cell suspension as a novel surgical approach in difficult-to-treat vitiligo: a randomized clinical trial [published online January 31, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.5795