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Melanocyte Transplantation for treatment of Vitiligo / Lukoderma in Delhi

Melanocyte Transplantation in Delhi at Care Well Medical Centre (South Delhi, CR Park)

Even now, after all these years, she can realize the moment when she first spotted a numb skin patch on her back. That was a coin sized white spot that had no feelings. This was an early phase of a disease called melanocyte.

Melanocyte, commonly known as vitiligo is a type of skin disease that affects a 2% of human population in India, every year. Though, this is not contagious it needs proper treatment to help control further spread of illness. Those, who are in the early phase of melanocyte or having their near and dear ones struggling with the disease may want to know what exactly melanocyte is. Let’s dig deeper in to the matter.

Definition: Cells of Neural crest origin found predominantly in the basal cell layer of the skin that helps in synthesis of melanin from tyrosine.

Mechanism of action
The melanin pigment is packaged in the melanosomes and these are transferred to the surrounding keratinocytes through the dendritic processes.

Types of melanocytic disorders

Ephelis
Ephelis is commonly known as Freckles and a common yet harmless lesion seen among the whites. These are red or light brown hyper pigmentation of the skin resulting due to the increased amount of basal keratinocytes and melanocytes.

Lentigo
Benign hyperplasia of the melanocytes occurring at all age but mostly seen in children and with no specific predilection of sex. This lesion includes oval, tan brown macules that appear like freckles but do not darken when exposed to light.

Melasma
These are mask like area of hyper pigmentation commonly seen in pregnancy.

Clinical appearance of areas of poorly defined blotchy macules in the cheeks, temples and forehead regions bilaterally is the main signs. Oral contraceptives, Hydantoin administration are some of the other etiological explanation to Melasma

Vitiligo
This disorder occurs as a result of partial or complete loss of melanocytes. It is also known as Lukoderma. It can occur unilaterally as well as bilaterally

Rate of prevalence

Vitiligo can cause minor to extensive changes in the skin. Rate of occurrence is about 3 percent to 4 percent of the entire population. Hereditary pre disposition is common in over 30 percent of the sufferers with the presence of first sign by the age of 20.

Signs of Vitiligo

Vitiligo consists of white symmetrical areas with darkened distinct borders. Hands face and areas that folds like armpits and elbows are affected most. Other most common sites are lips, orbits, back of the hands, nipples etc. besides the sun exposed sections.

Clinically the lesions are flat and well demarcated zones of pigment loss known as macules. The area of lesion may remain between few centimeters to over 100 centimeters. Wrists, Axillae, Peri oral and Peri orbital region are most affected. The progress is very abrupt in nature and may stop randomly after years of detoriation or vice versa.

Jennie..., whom we meet in the first paragraph of this write up, is still wondering why she had had vitiligo. Let’s find answer to her query.

Causes of Vitiligo

  • Auto immune deficiency such as Addison’s disease, thyroiditis
  • Endocrinal imbalance
  • Signs and symptoms of Melanoma
  • Change of skin color
  • Formation of mole and spots in abnormal quality and quantity
  • Change in the size of moles
  • Itches in some cases
  • Exposure to sun light due to the exposure to UV rays
  • Genetic pre disposition in various cases
  • Anemia
  • Artificial tanning devices
  • Nuerohormonal factors
  • Melanocytic self-destruction
  • Age pre disposition
  • Drug induced pigmentation (Amiodarone, Bleomycin, Busulfan)

Pretty well aware of her illness, now, Jennie decided to go for treatment to get rid of hideous white patches on her skin that make her look ugly.

Treatment

Vitiligo treatment is believed to be the best in India at Delhi. Dermatologists carry out intricate procedures to provide apt possible perfection. Proper psychological counseling is carried out to guarantee mental stability after the treatment.

The numerous approaches for handling Vitiligo treatment in Delhi are:

  • Camouflage Tattooing: Long-lasting disguise by simulated colorants into the affected areas.
  • Excision: the effected de-pigmented areas removed by primary cessation, and casing with a very thin Thiersch's graft.
  • Electro cautery and Cryo therapy
  • Skin Implanting: Various skin implanting techniques used are Punch grafting, split skin grafting and suction blister grafting.
  • Cellular Transplantation: The Melanocyte Transplantation and Cultured Melanocyte Transplantation are two advanced and highly accurate techniques recently introduced in Delhi that have been showing marked improvements in patients. It is only possible to have Melanocytic transplantation in Delhi and nowhere else in India.

Some of the age old techniques that is believed to give a small percentage of success includes Healing derma abrasion, laser ablation, and confined application of phenol or tri-chloro acetic acid.

Diagnostic investigations of Melanocytic Disorders

  • Diascopy: Diascopy is done to observe colour change while applying pressure with figure or glass slide
  • Dermatoscopy/ Epiluminescence microscopy: Magnified illuminated lenses are used to detect abnormal patterns below the skin. This test helps in diagnosis of malignant pigmented lesions.
  • Mycology sampling: Nail clippings, hair fragments and cutaneous scales are used in detection of fungal hypae and yeasts. 20% Potassium hydroxide is used to dissolve the keratin pigment, thus leaving behind the strands of floating hypae and yeasts.
  • Wood’s light: Ultraviolet radiation of 360 nun is used to detect cutaneous pigmented abnormalities
  • Prick test: This test is done with commercial stylets. The stylet is soaked in a selected antigen and the skin is pricked. Weal and flare formation after approximately 10 minutes is an indication of Type 1 hypersensitivity reaction of the skin.
  • Patch test
  • Swab test ( Bacterial swab test, Viral Swab test )
  • Histological study
  • Photo testing: Photosensitivity testing is done by performing photosensitivity testing under a specific graded series of dosage of UV rays
  • Biopsy: Biopsy is a technique used to remove a park of the affected tissue and sending them for histological analysis. Some of the various forms of biopsy are FNAC, Excisional biopsy, Block biopsy.
  • Immunofluorescence: Block of the sample extracted through biopsy is frozen in liquid nitrogen and sent for the special test called Immunofluorescence. The test involves a reaction between the body antigen and the flouoresceinelabeled antibodies

Histological finding specific to melanocytic lesions

  • Homogenous blue appearance
  • Starburst
  • Reticular network
  • Globular cobblestone

Management

  • Phototherapy with PUVA
  • Sun guard and protection
  • Corticosteroid therapy
  • Surgical excision of melanoma
  • Laser therapy
  • Chemotherapy following the surgical procedure

Prevention

  • High risk value assessment and screening
  • Protection against UV rays
  • Regular skin analysis
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