Poster Presentation Australasian Society for Dermatology Research Annual Scientific Meeting 2024

Non Cultured Epidermal Suspension - A Modified Protocol  (#113)

Raaisa Islam 1 , Monisha Gupta 1
  1. The Skin Hospital, Darlinghurst, NSW, Australia

Aim: Autologous non-cultured epidermal cellular suspension (NCES) grafting offers a promising solution for restoring skin pigment in patients with stable, localised vitiligo unresponsive to medical treatment. Our aim is to trial an alternative modified protocol of non-cultured epidermal cellular grafting using more widely available equipment that simplifies this process.

Methods: Five participants from The Skin Hospital, Sydney underwent our modified NCES protocol:

  1. Ultra-thin split thickness donor site graft taken.
  2. Graft transferred to trypsin- ethylenediaminetetraacetic acid solution, incubated at 37°C for 25 minutes, subsequently washed in phosphate buffered saline solution separating epidermis from dermis (performed in individual Petri dishes).
  3. Instead of repeated syringing, cell suspension passed through IV-giving set with filter, separating viable cells from larger debris.
  4. Recipientsite anesthetised, and then manually hyfrecated until pinpoint bleeding occurred.
  5. Cell suspension applied to recipient site.
  6. Procedure sites dressed.

Post-treatment care included topical tacrolimus ointment applied twice. Follow up occurred at 1 week and 1, 3 and 6 months, assessing Dermatology Life Quality Index (DLQI) and re-pigmentation. Excimer lamp treatment was recommended in the post-operative period to hasten re-pigmentation.

Results: Five participants (two male, three female) aged 30-40 years old, had Fitzpatrick skin type 4 or higher. Two participants had facial and three had limb lesions. At baseline, lesions ranged from 26-50% pigmentation. At 6 months, participants achieved re-pigmentation between 76-100%. DLQI improved in 5 participants and worsened in 2 participants. One case experienced hypertrophic scarring post procedure.

Conclusion: Our modified NCES protocol showed potential viability as an alternative to existing NCES protocols for vitiligo. The adjustments made, including the use of individual petri dishes, IV filter and hyfrecation of the recipient site (rather than dermabrasion) may prove to be effective alternatives to achieve re-pigmentation with minimal scaring, as well as cost-effective options compared to conventional techniques.