title: Treatment of vitiligo on difficult-to-treat sites using autologous noncultured cellular grafting.
abstract: BACKGROUND
  Because of the limitations of medical treatment, various surgical therapies have been developed and are being accepted to treat vitiligo. However, certain areas such as the fingers and toes, palms and soles, lips, eyelids, nipples and areolas, elbows and knees, and genitals are considered difficult-to-treat areas.
  
  
  OBJECTIVE
  To evaluate data pertaining to individual sites considered to be difficult to treat and highlight that noncultured melanocyte-keratinocyte transplantation (MKT) does not require any special precautions to treat these anatomical sites.
  
  
  METHODS
  Forty patients (13 male and 27 female) with bilateral vitiligo and nine (4 male and 5 female) with unilateral vitiligo were treated using noncultured MKT, for "difficult-to-treat" sites at the National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia, and were analyzed for response according to region. Repigmentation was graded as excellent with 95% to 100% pigmentation, good with 65% to 94%, fair with 25% to 64%, and poor with 0% to 24% of the treated area.
  
  
  RESULTS
  For bilateral vitiligo, more than 50% of patients treated for difficult sites showed more than 65% repigmentation of the treated areas. For unilateral vitiligo, all of the patients except for two treated for the eyelids showed more than 65% repigmentation of the treated area.
  
  
  CONCLUSIONS
  The concept of a "difficult-to-treat site" is a relative term and depends upon the technique used. The noncultured MKT does not require any special precautions to treat these anatomical sites. This review may help physicians to change the concept of "difficult-to-treat site."
authors.affiliation: National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia. mulekar@gmail.com
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Mulekar
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Issa
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al Eisa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D015603:Keratinocytes / Q000637:transplantation*; D008297:Male; D008544:Melanocytes / Q000637:transplantation*; D008875:Middle Aged; D012880:Skin Pigmentation; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D014820:Vitiligo / Q000601:surgery*