Non-Segmental Vitiligo

r EGENERATIVE
e PITHELIAL
s USPENSION
Non-Segmental Vitiligo
The role of RES
in the clinician’s
toolkit.
TM
Restores pigmentation7,12-15
Non-cultured and immediately available
within minutes1
Completed in a simple, single procedure at
the point of care
The Case: Fast Facts
• A 33-year-old female had non-segmental vitiligo which had been stable for five years
• A 25 cm2 area was prepared by CO2 laser and treated with RES applied to the site
TM
• By 18 weeks post treatment pigmentation and skin texture matched the surrounding area
Pre-treatment
18 weeks post-treatment
How RES works...
TM
Effective healing and the formation of good quality skin requires the presence and products of
keratinocytes, fibroblasts and melanocytes.2-5 These cells are highly interactive and communicate
with each other via secreted factors, their receptors and via cell/cell contacts to regulate the
function and phenotype of the skin.5,6,8,9 RESTM contains viable populations of all the skin cell
phenotypes1 that have been shown to be essential for normal regeneration and pigmentation of
the skin.4,6,9
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transforming lives
Using RES to treat Non-segmental Vitiligo
r EGENERATIVE
e PITHELIAL
s USPENSION
Non-Segmental Vitiligo
Background
A 33-year-old patient presented with non-segmental vitiligo which had been stable
for five years. Previous treatment included: narrow band UVB phototherapy and
minigrafting with no improvement to the depigmented area. A 25 cm2 area of the
patient’s lower right leg (shin) was selected for treatment with RES™.
Treatment
A 1.5 x 1.0 cm, 0.2 mm split-thickness skin sample was harvested from the left hip
with a manual dermatome under local anaesthesia and processed using a ReCell®
device. The vitiligo lesion to be treated was prepared under local anaesthesia using
a 10,600 nm CO2 laser with the following parameters: 200 mJ 60 W, lateral one
pass, medial two passes (first at 200mJ, second at 100mJ). The RES™ produced
from the skin sample using the ReCell® device was dripped onto the donor and
recipient sites. Telfa™ Clear Dressings (Covidien, Dublin, Ireland) (primary) covered
with Jelonet™ (Smith & Nephew, London, UK) (secondary) and then Primapore™
dressing (Smith & Nephew, London, UK) were applied to both sites. Klacid SR 500
(a prophylactic antibiotic) was prescribed for seven days. UVA therapy was initiated
six weeks after treatment.
Pre-treatment
Results
Secondary dressings were removed two days post-procedure; the primary dressings
five days later. Seven days post-procedure, no inflammation was present, and there
was no evidence of infection. The donor site was considered healed at this time. The
treated area was partially healed with 75% re-epithelialisation of the total area. The
treated area was covered with a Telfa™ Clear Dressing for an additional seven days
after which normal skin care resumed. Both patient and doctor were satisfied with the
results at this point post-procedure. At 18 weeks post-procedure, the treated area
was completely healed, with colour, pigment and texture matching the surrounding
skin. UVA treatment was discontinued. Both patient and doctor were extremely
satisfied with the results.
1 week post-treatment
Benefits
This report describes the use of RES™ for the treatment of a stable non-segmental
vitiligo lesion of the lower right leg in a patient who had previously undergone several
procedures including narrow band UVB phototherapy and minigrafting with no
improvement. In this patient, RES™ was highly effective in restoring normal colour,
pigment, and texture by 18 weeks post-treatment, with the area matching the
surrounding untreated skin in all aspects. Dyspigmentation (hypopigmentation or
hyperpigmentation) of the treated area did not occur. Similar success with RES™ for the
treatment of vitiligo has been reported in the literature.10-15 Unlike other conventional
therapies for vitiligo, RES™ does not require specialized equipment or a dedicated
laboratory space. All reagents necessary to produce RES™ from a small skin sample
for application within approximately 30 minutes are provided in a convenient single
use device which can be used in the same room as the procedure - ReCell®.
18 weeks post-treatment
Clinical References
CS_RES_01.1
1. Wood FM, Giles N, Stevenson A, Rea S, ZFear M. Characterisation of the cell suspension harvested from
the dermal epidermal junction using a ReCell® kit. Burns 2012; 38:44-51.
2. Rheinwald JG, Green H. Serial cultivation of strains of human epidermal keratinocytes: the formation of
keratinizing colonies from single cells. Cell 1975; 6(3):331-343.
3. Green H, Rheinwald JG, Sun T. Properties of an epithelial cell type in culture: the epidermal keratinocyte
and its dependence on products of the fibroblast. Progress in Clinical and Biological research, 1977;
17:493-500.
4. Singer AJ, Clark RAF. Cutaneous wound healing. New England Journal of Medicine 1999;341(10):738746.
5. Pastar I, Stojadinovic O, Yin NC, Ramirez H, Nusbaum AG, Sawaya A, Patel SB, Khalid L, Isseroff RR,
Tomic-Canic M. Epithelialization in wound healing: A comprehensive review. Advances in Wound Care 2014;
3(7):445-464.
6. Sorrell JM, Caplan AI. Fibroblast heterogeneity: more than skin deep. J Cell Sci. 2004;117(Pt
5):667–675.
7. Navarro FA, Stoner ML, Lee HB, Park CS, Wood FM, Orgill DP. Melanocyte repopulation in full-thickness
wounds using a cell spray apparatus. Journal of Burn Care and Research 2000; 22(1): 41-46
8. Hirobe T. Role of keratinocyte-derived factors involved in regulating the proliferation and differentiation of
mammalian epidermal melanocytes. Pigment Cell Research 2004; 18:2-12.
9. Yamaguchi Y, Brenner M, Hearing VJ. The regulation of skin pigmentation. Journal of Biological Chemistry
2007; 282(38): 27557-27561.
10. Mulekar SV. Long-term follow-up study of segmental and focal vitiligo treated by autologous, noncultured melanocyte–
keratinocyte cell transplantation. Arch Dermatol 2004;140:1211–5.
11. Mulekar SV. Long-term follow-up study of 142 patients with vitiligo vulgaris treated by autologous, non-cultured
melanocyte– keratinocyte cell transplantation. Int J Dermatol 2005;44:841–5.
12. Cervelli V, DeAngelis B, Balzani A, Colicchia G, Spallone D, and Grimaldi M.Treatment of stable vitiligo by ReCell system.
Acta Dermatovenerologica Croatica. 2009;17(4):273-278.
13. Cervelli V, Spallone D, Lucarini L, Palla L, Brinci L, and DeAngelis B. Treatment of stable vitiligo hands by ReCell system:
preliminary report. European Review for Medical and Pharmacological Sciences. 2010;14(8):691-694.
14. Mulekar SV, Ghwish B, Al Issa A, and Al Eisa A. Treatment of vitiligo lesions by ReCell vs. conventional
melanoyce-keratinocyte transplantations a pilor study. British Journal of Dermatology. 2008:158:45-49.
15. Komen L, Vrijman C, Tjin EPM, Krebbers G, de Rie MA, Luiten RM, van der Veen JPW, Wolkerstorfer A. Autologous cell
suspension transplantation using a cell harvesting device in segmental vitiligo and piebaldism patients: a randomized controlled pilot
study. J Am Acad Dermatol 2015; 73(1):170-172.
Acknowledgements: Avita Medical thanks L.Komen and A. Wolkerstorfer at the Netherlands
Institute for Pigmentation Disorders for presenting this case.
© Avita Medical 2015
transforming lives