الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Vitiligo represents an acquired depigmenting skin disorder worldwide, with an unpredictable course and a significant psychosocial impact. The aetiology of vitiligo is multifactorial, with each factor contributing in the pathogenesis of the progressive loss of melanocytes in the genetically predisposed individual.
Vitiligo has been categorized into nonsegmental vitiligo (including acrofacial, mucosal, generalized, universal, mixed and rare variants) and segmental vitiligo. It has characteristic clinical appearance in the form of well-defined depigmented macules or patches that may need wood’s lamp confirmation especially in fair skin phototype.
Current therapeutic approaches are directed towards halting disease progression and inducing repigmentation. This could be achieved by means of conventional medical methods (as topicals, oral immunomodulators and phototherapy) and surgical procedures (including tissue grafts and cellular grafts).
In cases of medically resistant stable vitiligo, surgical management is considered. Significant progress has been made in the surgical modalities and procedures used to harvest and transplant melanocytic cells. It aims to induce satisfactory repigmentation and improve the quality of life.
Non-cultured epidermal cell suspension (NCES) is an efficient and feasible procedure. It has shown good efficacy in treating large vitiligo areas with low cost. There have been various modifications in NCES preparations since its adoption by Gauthier et al. Various modalities have been discussed in literature for recipient site preparation including: manual or motorized dermabrasion, using liquid nitrogen to induce cryoblister, derma roller and laser ablation. All of them yield variable results.
The adjuvant use of PRP in combination to the surgical methods was postulated to produce better repigmentation outcome. This was explained by the presence of various growth factors that promoted melanogenesis. Homogenizing the non trypsinized epidermal cellular suspension with plasma gel is a novel methos. It formed a mesh that entrapped epidermal cells and pre-synthesized growth factors which promoted melanogenesis. Subsequent narrow-band UVB therapy following surgical interventions have established to promote better expansion and spread of grafted melanocytes.
The aim of this study is to compare autologous non-cultured, trypsinized epidermal cell suspension in recipient site prepared by cryoblebbling and non-cultured, non-trypsinized epidermal cell graft homogenized with plasma gel in producing repigmentation in treatment of stable vitiligo followed by NB-UVB.
Thirty patients with stable vitiligo were recruited to the study, after fulfilling the inclusion criteria, by closed envelope method. Fifteen patients (group A) underwent non-cultured trypsinized epidermal cell suspension in recipient site prepared by cryoblebbling, where surgical grafting was performed over two consecutive days. The other fifteen patients (group B) underwent non-cultured non-trypsinized epidermal cell graft homogenized with plasma gel, as a one-day grafting procedure. One to two weeks later all patients were exposed to NB-UVB phototherapy two times per week for 3 months with monthly digital photographs.
Both groups were assessed according to age, sex, skin type, type of vitiligo, body surface area affected, duration of disease, duration of stability, VIDA score, donor to recipient ratio and site of vitiligo patch treated. The plasma gel group showed earlier onset of repigmentation and the faster duration of healing compared to the cryobleb group with statistically significant difference between the two studied groups. This was due to the released growth factors which promoted melanogenesis and enhanced wound healing.
The extent of overall repigmentation after 3 months of phototherapy was maintained higher in the plasma gel group compared to the cryobleb group, yet no statistically significant difference was found between the two studied groups. The acrals in both groups showed poor outcome of repigmentation supporting that regardless of the surgical procedure performed, they were the most challenging areas to respond.
The degree of color matching of the repigmented area to the surrounding skin was better in the plasma gel group, with a more uniform homogenous repigmentation. However, no statistically significant difference was noted between the two groups. In both groups, the degree of color match was significantly better with greater extent of repigmentation, expressed as statistically significant positive correlation. Patient’s satisfaction was better in the plasma gel group, but this was not statistically significant. It was concluded that the better the overall cosmetic appearance regarding repigmenting color match, the higher the patient satisfaction was. This was demonstrated as a statistically significant positive correlation between patient’s satisfaction and color match in both groups.