ReCell® Effective Treatment for Nipple-Areola Complex Vitiligo

Zhifei Liu, MD

Investigators from China considered the autologous cell-harvesting device ReCell® (Avita Medical) to be a feasible and efficient treatment strategy for nipple-areola complex vitiligo.

In addition to palms, elbows, and lips, vitiligo has been known to affect the skin of nipple-areola complex (NAC), which is considered a “difficult-to-treat” area as they are sparse of hair follicles and less responsive to medical or phototherapies.

Though treatments do exist, such as split-thickness skin grafting, mini-punching grafting, and suction blister epidermal grafting, they are limited to cases with small lesions. Additionally, new methods such as transplantation of cultured epidermis or melanocyte are considered time-consuming, laborious, and ethically controversial.

In earlier reports, ReCell® had been cumulatively reported to facilitate epithelialization, repair superficial skin defects and scars, and enhance appropriate pigmentation.

The team, led by Zhifei Liu, MD, Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, also noted that the device had been applied in stable vitiligo with promising therapeutic effects.

For the newest study, Liu and colleagues determined if ReCell® was an efficient and convenient method for stable vitiligo in the nipple-areola complex area.

The Study

Liu and investigators reviewed medical records of all NAC- affected vitiligo patients from the Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH) from October 2016 to April 2020.

A total of 18 NAC-affected vitiligo patients were chosen for the study, 14 of whom were female and 4 who were male.

The grafting procedures followed the guidance of ReCell®10 and were all completed by the senior author (Liu).

A 0.2–0.3 mm split- thickness skin graft was harvested by a razor blade from unaffected areas or the inner thigh area, which was approximately 1/20 to 1/40 of the treated area. Cellular suspension was obtained when the graft was treated with the ReCell® kit.

Dermabrasion of vitiligo patches was performed, and the recipients were cocered with a Telfa TM dressing (Covidien) for 7 days in the appropriate areas.

Patients were followed up 3, 6, and 12 months, respectively, after operation, and the grade of repigmentation was classified into excellent, good, fair, and poor according to the repigmentation rate of ≥90%, 75–90%, 50–75%, and ≤50%.

The Findings

Liu and colleagues reported that though the procedure was painful, and had possible complications such as infection and scar formation, no surgical complications occurred in all the patients.

Additionally, after 3 months of treatment, skin repigmentation was observed both under natural light and the Wood's light, and the mean repigmentation rate was 78.7 ± 5.8% (excellent, 1; good, 10; and fair, 7) in the NAC area and 70.4 ± 6.9% (good, 3; and fair, 15) in the non-NAC area (p < 0.01).

At the 6-month follow-up, the mean repigmentation rate was 87.6 ± 5.1% (excellent, 6; and good, 12) in the NAC area and 84.2 ± 5.7% (excellent, 3; good, 14; and fair, 1) in the non-NAC area (p < 0.05). At the 12th-month follow-up, the mean repigmentation rate was 96.1 ± 3.5% (excellent, 17; and good, 1) in the NAC area and 93.2 ± 3.6% (excellent, 14; and good, 4) in the non-NAC area (p < 0.05).

Overall, patients considered the treatment results satisfactory, and Liu and colleagues believed the treatment could go beyond the NAC area.

“Our study suggests that ReCell® is a simple and efficient method used for vitiligo treatment in both the commonly reported areas and the NAC,” the team wrote. “This technique also has the potential to treat other areas recalcitrant to traditional treatment such as palms, elbows, and lips.”

The study, “Repigmentation of nipple-areola complex after ReCell® treatment on breast vitiligo,” was published online in the Journal of Cosmetic Dermatology.