Regenerative Medicine Proves to Be Effective for Vitiligo Treatment

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A recent systemic review observed the efficacy and safety of various types of regenerative medicine in treating vitiligo.¹ Cell therapy and platelet-rich plasma (PRP) showed the most optimal results but significant repigmentation was noted in other methods such as platelet-poor plasma injection, cell therapy based on hair follicle transplantation, melanocyte transplantation, keratinocyte transplantation, melanocyte-keratinocyte suspension in PRP, and systemic injection of mesenchymal stem cells.

With the overall goal of regenerating tissue and restoring lost skin cells, clinicians have used regenerative medicine to treat other inflammatory skin diseases and external injuries such as androgenic alopecia and hypertrophic scarring.²

Researchers searched through databases including PubMed, Scopus, Embase, and Web of Science. When analyzing articles, reviewers noted study characteristics such as participant demographics, improvement criteria, and intervals of follow-up. EndNote X8 and Google Sheets were used to screen the articles, extract data, and categorize each accordingly. Additionally, the risk of bias for each included study was evaluated using the Cochrane Risk of Bias 2.0 tool.

Out of 877 total articles, 48 eligible ones were selected for the final review. These involved 2186 patients with vitiligo in 76 intervention groups. Almost half of participants were women, and the average age of participants was 29.7 years. Among the included studies, 26 were randomized clinical trials (54.2%), 15 were single-arm clinical trials (31.2%), 5 were non-randomized clinical trials (10.4%), and 2 studies were case series(4.2%).

Autologous non-cultured melanocyte-keratinocyte transplantation was seen in 802 patients, in which over 50% achieved repigmentation within 9 months. Combining the melanocyte transplantation with NB-UVB phototherapy also had noteworthy results, with a 42% reduction in depigmented patches.

PRP injection in 338 patients also exhibited significant repigmentation with an average repigmentation of 58.7%. One study compared PRP to microneedling and found it to be superior, with a repigmentation rate of 58.7%. When combined with CO2 laser treatment, 40% of patients observed over 75% repigmentation after 3 months. Strong results were also found in other combination therapies including NB-UVB, and Psoralen and sunlight (PUVASOL).

Utilized in 268 patients, cell transplantation with hair follicle origin yielded good to excellent repigmentation at the 4-to-6-month mark. Combining hair follicle transplantation with calcipotriol betamethasone dipropionate and NB-UVB saw success in 93.8% and 81.2% of patients, respectively

Isolated melanocyte transplantation was used in 572 patients and all relevant studies noted a significant improvement in repigmentation (p ≤ 0.05). Similar results were seen in studies that investigated the effectiveness of melanocyte-keratinocyte suspension in PRP (p ≤ 0.05).

Certain methods including a combined cell transplantation with epidermal and hair follicle origin, the combination of melanocyte-keratinocyte transplantation with plasma-rich fibrin, and platelet-poor plasma injection, were only tested in 1 study each but still saw a significant difference in repigmentation rates.

Some common adverse effects in the therapies included pain, erythema, swelling, bruising, redness and risk of infection at the injection sites. These were all mild to moderate and no serious adverse events were reported.

Additionally, the risk of bias assessment indicated that 37.21% of studies were low risk and 13.95% had some concerns. Nearly half were rated as having overall higher risk.

“While bias due to missing outcome data and outcome measurement was generally well managed, some concerns still remain. Encouragingly, all studies demonstrated low risk for selective reporting,” the authors wrote. “These findings align with previous dermatology reviews, indicating the need for more rigorous study designs, transparent randomization methods, and strict intervention adherence to enhance research quality in vitiligo treatment.”

Overall, each regenerative therapy showed promising results, especially when combined with other methods to enhance the recovery rate. While regenerative medicine holds much potential for future vitiligo treatment, further trials are necessary to explore unexplored, additional methods such as stromal vascular fraction and exosomes, and incorporate long-term follow-up data. This research can better inform clinicians on the sustainability and impact on patients’ quality of life that is associated with these treatment strategies.

References

1. Jafarzadeh A, Mohammad AP, Goodarzi A. A Systematic Review of Case Series and Clinical Trials Investigating Regenerative Medicine for the Treatment of Vitiligo. J Cosmet Dermatol. Published online November 7, 2024. doi:10.1111/jocd.16660

2. Jafarzadeh A, PourMohammad A, Goodarzi A. A systematic review of the efficacy, safety and satisfaction of regenerative medicine treatments, including platelet-rich plasma, stromal vascular fraction and stem cell-conditioned medium for hypertrophic scars and keloids. Int Wound J. 2024;21(4):e14557. doi:10.1111/iwj.14557