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Noncultured epidermal cell suspension for the treatment of recalcitrant segmental vitiligo in a solid-organ transplant recipient
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The lesions began five years ago when the patient was under pegylated interferon alfa-2a treatment due to an IgA nephropathy associated with hepatitis B. After his diagnosis of VS he treated the lesions with topical betamethasone dipropionate cream 0.05% and tacrolimus ointment 0.1% for four months without improvement. The patient also underwent 85 treatments of narrowband UVB therapy, with only 25% improvement. His nephropathy worsened, and the patient started hemodialysis followed by renal transplantation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Skin lesions at the time of consultation were distributed in a blaschkoid fashion and were clinically compatible with SV stable for the last four years.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Due to the risk of carcinogenesis, we contraindicated more phototherapic treatments and planned the NCES procedure. First, we obtained a thin partial-thickness skin graft with 8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> under local anesthesia from his left medial thigh with the assistance of a shaving blade. Then, the graft was incubated at 37<span class="elsevierStyleHsp" style=""></span>°C in a trypsin 0.25% with Ethylenediaminetetraacetic Acid (EDTA) solution for fifty minutes. After that, we used a fine forceps to separate the epidermis from the dermis, allowing detachment of basal epidermal cells in normal saline. The solution was transferred to a test tube, and we obtained a cell pellet after five minutes centrifugation at 1500<span class="elsevierStyleHsp" style=""></span>rpm.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The recipient site was delimited (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and prepared by superficial dermabrasion under local anesthesia (lidocaine 1% without epinephrine). The cell pellet was resuspended in 1.5<span class="elsevierStyleHsp" style=""></span>mL of normal saline and transferred to the recipient site. A collagen sheet, petrolatum gauze, regular gauze, and transparent adhesive film were positioned over the area and dressings were kept in place for seven days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">At the time of the procedure, the patient was on the use of everolimus 1<span class="elsevierStyleHsp" style=""></span>mg/day, tacrolimus 3<span class="elsevierStyleHsp" style=""></span>mg/day and prednisone 10<span class="elsevierStyleHsp" style=""></span>mg/day since the last year. Due to his immunosuppression, we prescribed oral antibiotic therapy (cefadroxil 500<span class="elsevierStyleHsp" style=""></span>mg b.i.d.) for seven days. The patient did not receive postoperative phototherapy.</p><p id="par0045" class="elsevierStylePara elsevierViewall">After three months a diffuse repigmentation on 95% of the recipient site started to become visible, becoming more evident after six months (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Main therapeutic approaches for SV include corticosteroids, topical immunomodulators and phototherapy. Although phototherapy is considered a first-line treatment in vitiligo,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> the response of SV to modalities such as UVBnb is limited. A Korean study showed repigmentation rates varying from 26.3% to 50% in SV patients treated with UVBnb.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Besides, although NBuvb studies have not found a significant association between treatment modality and keratinocyte carcinomas or melanomas in immunocompetent patients,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> special considerations must be done regarding this treatment in SOT population. Compared with the general population, SOT recipients are between 65 and 250 times more likely to develop skin spindle cell carcinomas.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Our patient presented with vitiligo lesions which were stable for five years. The disease stability is the main criteria in the indication of surgical treatment of vitiligo, once its presence is directly related to better outcomes.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In theory, due to chronic use of immunosuppressants drugs, SOT population tends to present a more stable disease, being good candidates to the surgical procedure.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although there is evidence supporting the use of pre and postsurgical phototherapy to improve outcomes in the surgical management of vitiligo, we can consider NCES without phototherapy as monotherapy for situations such as SOT patients, in which UV exposure is contraindicated.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Gerson Dellatorre: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Caio César Silva de Castro: Approval of the final version of the manuscript; conception and planning of the study; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-10-10" "fechaAceptado" => "2019-02-19" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Dellatorre G, Silva de Castro, CC. Noncultured epidermal cell suspension for the treatment of recalcitrant segmental vitiligo in a solid-organ transplant recipient. An Bras Dermatol. 2020;95:257–8.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Clínica Tarlé, Curitiba, PR, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1561 "Ancho" => 1074 "Tamanyo" => 153280 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Achromic patches with blaschkoid distribution demarcated on the left arm (24<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1566 "Ancho" => 1074 "Tamanyo" => 125667 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Repigmentation on 95% of recipient site after six months with slight hypochromia.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1570 "Ancho" => 1074 "Tamanyo" => 80555 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Wood's lamp examination shows diffuse repigmentation pattern.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitiligo-Part 1" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.G. 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Murphy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2005.07021.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2006" "volumen" => "154" "paginaInicial" => "498" "paginaFinal" => "504" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16445782" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000002/v1_202004180640/S0365059620300295/v1_202004180640/en/main.assets" "Apartado" => array:4 [ "identificador" => "82769" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000002/v1_202004180640/S0365059620300295/v1_202004180640/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300295?idApp=UINPBA00008Z" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 21 | 10 | 31 |
| 2024 Outubro | 91 | 60 | 151 |
| 2024 Setembro | 128 | 74 | 202 |
| 2024 Agosto | 133 | 86 | 219 |
| 2024 Julho | 144 | 101 | 245 |
| 2024 Junho | 123 | 67 | 190 |
| 2024 Maio | 95 | 48 | 143 |
| 2024 Abril | 94 | 84 | 178 |
| 2024 Março | 84 | 67 | 151 |
| 2024 Fevereiro | 87 | 69 | 156 |
| 2024 Janeiro | 50 | 44 | 94 |
| 2023 Dezembro | 74 | 60 | 134 |
| 2023 Novembro | 69 | 73 | 142 |
| 2023 Outubro | 60 | 85 | 145 |
| 2023 Setembro | 81 | 66 | 147 |
| 2023 Agosto | 60 | 39 | 99 |
| 2023 Julho | 48 | 31 | 79 |
| 2023 Junho | 70 | 41 | 111 |
| 2023 Maio | 47 | 13 | 60 |
| 2023 Abril | 34 | 21 | 55 |
| 2023 Março | 55 | 40 | 95 |
| 2023 Fevereiro | 41 | 32 | 73 |
| 2023 Janeiro | 32 | 28 | 60 |
| 2022 Dezembro | 46 | 19 | 65 |
| 2022 Novembro | 54 | 46 | 100 |
| 2022 Outubro | 63 | 54 | 117 |
| 2022 Setembro | 36 | 58 | 94 |
| 2022 Agosto | 43 | 29 | 72 |
| 2022 Julho | 45 | 56 | 101 |
| 2022 Junho | 43 | 55 | 98 |
| 2022 Maio | 38 | 50 | 88 |
| 2022 Abril | 36 | 38 | 74 |
| 2022 Março | 48 | 64 | 112 |
| 2022 Fevereiro | 25 | 31 | 56 |
| 2022 Janeiro | 50 | 73 | 123 |
| 2021 Dezembro | 40 | 51 | 91 |
| 2021 Novembro | 30 | 64 | 94 |
| 2021 Outubro | 56 | 59 | 115 |
| 2021 Setembro | 37 | 47 | 84 |
| 2021 Agosto | 26 | 41 | 67 |
| 2021 Julho | 31 | 41 | 72 |
| 2021 Junho | 24 | 53 | 77 |
| 2021 Maio | 43 | 78 | 121 |
| 2021 Abril | 109 | 180 | 289 |
| 2021 Março | 42 | 42 | 84 |
| 2021 Fevereiro | 21 | 22 | 43 |
| 2021 Janeiro | 17 | 15 | 32 |
| 2020 Dezembro | 20 | 21 | 41 |
| 2020 Novembro | 13 | 11 | 24 |
| 2020 Outubro | 10 | 8 | 18 |
| 2020 Setembro | 16 | 7 | 23 |
| 2020 Agosto | 10 | 6 | 16 |
| 2020 Julho | 13 | 7 | 20 |
| 2020 Junho | 12 | 15 | 27 |
| 2020 Maio | 11 | 16 | 27 |
| 2020 Abril | 2 | 3 | 5 |
| 2020 Fevereiro | 0 | 2 | 2 |
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