New transplant that restores colour to skin damaged by vitiligo

Vassoo Devan arian, a retired NHS nurse, was horrified when a friend asked if the pale patches of skin he’d developed were leprosy. vassoo had assumed the tiny white patches — smaller than a 10p piece — on his nose, scalp and hands were the result of sun damage.

‘i had been swimming in the sea a lot on a recent trip to Mauritius,’ recalls vassoo, 72, who lives with his wife Muriel, 70, in Quedgeley, Gloucestershire. ‘My GP agreed that it was probably down to too much sun.’

But over the next couple of months, the patches became paler and paler. ‘People would stare. i started to dread going out,’ he says. ‘My GP just kept prescribing moisturisers and didn’t say what it was.’

a special make-up he was also prescribed was ‘effective as a cover-up’, says vassoo, ‘but when i sweated or went swimming, it came off and people would stare at me. it was also messy to apply’.

after two years, vassoo was referred to a dermatologist who diagnosed vitiligo — a condition he says he has beaten, thanks to a radical new approach: a skin transplant.

vitiligo is one of the most common autoimmune skin diseases and is caused by a lack of melanin, the pigment that gives skin its colour: the body’s immune system attacks the pigment cells, mistaking them for foreign invaders.

This causes painless white patches on exposed areas such as the face and fingers, although they can also appear on the wrists, around the eyes, groin, armpits and inside the mouth.

The disease affects around one in 200 people, and about 50 per cent develop their first symptoms before the age of 20, though it’s not clear why.

However, ‘stressful’ events, such as childbirth, hormone changes or even cuts to the skin, may trigger it — there is also a genetic link. ‘it affects all skin types, but is not normally as visible on fair skin,’ says Dr Howard stevens, a consultant dermatologist at the skin Care network in London.

There are two types of vitiligo. The most common — so-called generalised symmetrical type — affects both sides of the body symmetrically, as the name suggests.

SeGMenTaL vitiligo affects only one area of the body and is less likely to progress — it is more responsive to treatment because a smaller area is affected.

There is no cure, but some treatments can reverse pigment loss if used early enough. These include topical steroids, to calm inflammation, and vitamin D cream, thought to have a protective effect on melanocytes, the cells that produce pigment in skin.

other options include pimecrolimus and tacrolimus, creams that are usually used for eczema, which can help repigment the skin, says Dr stevens.

‘Protecting your skin from the sun is also important, as the white areas have no pigment to protect them from ultraviolet light.’ if topical treatments don’t work, narrow UvB (ultraviolet B) light phototherapy can be useful, says Dr stevens, given either alone or with protopic cream, an immunosuppressant treatment that turns off the autoimmune reaction.

The ultraviolet light stimulates the melanocytes (in a similar way, melanocytes proliferate when exposed to sunlight, to darken and protect the skin against sun damage). The treatment is available in some nHs hospitals.

Dr stevens also uses an excimer laser, available privately at £100 to £150 a session, to re-pigment the white patches using a narrow band ultraviolet light.

‘it is a useful technique for small areas, such as the face and neck, and its advantage over phototherapy is that it can be focused on the treatment area, rather than irradiating the whole body,’ explains Dr stevens. He adds that phototherapy needs more treatments and the UvB light has a higher risk of skin cancer.

another option is PUva (psoralen ultraviolet a) light treatment, where the patient is given a drug to make them more sensitive to light — they are then exposed to Uv light twice weekly for up to two years. it is available both privately and on the nHs.

it’s useful, but not for the very fair-skinned because of the higher risk of skin cancer, says Dr stevens. ‘Dermatologists are less keen on PUva, because it causes quite a lot of genetic damage: 200 treatments — which some patients may need — can increase the risk of skin cancer eightfold.’

Dr stevens adds: ‘With all treatments, the white patches can come back; there’s no total cure.’

in 2013, after around five years of symptoms, vassoo’s dermatologists suggested phototherapy — he had this for two months, but, he says, ‘it didn’t work for me and i was worried about the increased risk of skin cancer and didn’t want to expose my whole body to the light treatment when only small areas were affected’.

vassoo heard about a type of pigment transplant surgery called renovaCell. Here, melanocytes are taken from unaffected areas of skin and moved onto the vitiligo patches; the excimer laser is then used to stimulate the production of pigment cells.

it is only available privately, and can cost up to £4,000.

vassoo had the treatment at a private clinic in Manchester run by Dr vishal Madan, a consultant dermatologist and president of the British Medical Laser association, who says he’s been using the technique for five years with good results.

‘i’m very careful about which patients i use this technique on — they have to have vitiligo that affects only a small area and has been stable for at least six months to be suitable,’ explains Dr Madan.

‘We prepare the skin by using either a laser or a tool to injure the vitiligo patch, making it ready for the transplanted cells.

‘Then i remove a 1-2cm square of skin from the thigh, taking just a thin, superficial layer, and put this into a chemical solution. This separates the pigment cells from fibrous tissue.

‘i then harvest the cells from the chemical solution with a syringe and apply to the area of skin affected by vitiligo.’

THis is followed by a series of excimer laser treatments — anything from six to 40 sessions. vassoo had fewer than ten, each lasting less than three minutes.

‘Pigment transplant treatment is regarded as experimental in the UK,’ says Dr Madan. ‘There aren’t many options we can offer people, and some are willing to try this because they are so fed up with other ineffective treatments.’

a study published in June in the Journal of the american academy of Dermatology by the Henry Ford Hospital in the U.s. found that the majority of patients who’d had the treatment still had a very good or excellent colour match five years later.

However, although pigment transplantation is a ‘promising treatment’, there is a lack of evidence on its long-term effectiveness, says Dr viktoria eleftheriadou, a vitiligo researcher at the University of nottingham and spokesperson for the British association of Dermatologists.

she adds: ‘it’s still experimental. We need more research to find out what the relapse rate is.’

Two years on, vassoo is delighted with his treatment: ‘i know its long-term effectiveness is not guaranteed, but my vitiligo was bothering me so much, i thought it would be worth it. i don’t feel self-conscious any more.’