Review Efficacy and safety of noncultured melanocyte-keratinocyte transplant procedure for vitiligo and other leukodermas: a critical analysis of the evidence Paras P. Vakharia 1, *, PharmD, Dylan E. Lee 2, *, BS, and Amor Khachemoune 3 , MD, FAAD, FACMS 1 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA, 2 Creighton University School of Medicine, Omaha, NE, USA, and 3 Dermatology Service, Veterans Affairs Hospital & SUNY Downstate Medical Center, Brooklyn, NY, USA Correspondence Amor Khachemoune, MD, FAAD, FACMS Dermatology Service Veterans Affairs Hospital & SUNY Downstate 800 Poly Place Brooklyn, NY 11209 USA E-mail: amorkh@gmail.com *These authors contributed equally to this work. Funding: None. Conflicts of interest: None. doi: 10.1111/ijd.13895 Abstract Vitiligo is an acquired pigmentary skin of depigmentation occurring secondary to melanocyte destruction. Vitiligo and other leukodermas have a profound impact on quality of life. Current therapies include medical options, such as phototherapy, topical and systemic corticosteroids, topical calcineurin inhibitors, immunomodulators, and antioxidiants, and surgical options. Surgical options provide melanocytic cells to previously depigmented areas and use either tissue grafting or cellular grafting methods. Topical treatments are often insufficient, and many of the current surgical procedures have shown variable response rates. In this review, we discuss the process of the cellular grafting melanocyte-keratinocyte transplantation procedure (MKTP) and critically analyze its efficacy and safety in the treatment of vitiligo and other leukodermas. PubMed was searched for studies (2001–2017) describing the use of MKTP in patients with vitiligo or other leukodermas. Articles or trials discussing the use of MKTP for these patients were selected for in-depth review. Clinically relevant results regarding efficacy and safety of MKTP in vitiligo and leukoderma patients were analyzed. Numerous trials and case series/ reports have demonstrated tolerability and efficacy of MKTP with repigmentation for patients with refractory, stable vitiligo. However, the response rates have been variable, likely influenced by vitiligo type and affected areas. Future research and clinical reporting will provide more insight on which phenotypes may benefit from MKTP. Introduction Vitiligo is an acquired pigmentary skin disease and form of leuko- derma that presents with well circumscribed, depigmented mac- ules and patches occurring secondary to the destruction of melanocytes. 1–4 Any area of the body can be affected, though the face, upper chest, dorsal hands, axillae, and groin are most commonly involved. 3 Although the cause of this condition is unknown, multiple theories (each of which may likely contribute) have been proposed, including autoimmune, neurohumoral, cyto- toxic, and oxidative stress hypotheses. 1,3,4 Vitiligo, which affects approximately 0.5–1% of the population, occurs in patients of all ages, but almost half present before 20 years of age. 1–3 Men and women are equally affected, and there is no difference in preva- lence with respect to skin type or race. 1–4 The psychological bur- den of this condition and associated impact on quality of life can be significant, especially in those with darker skin types. 1,3 Vitiligo can be divided into two main forms: nonsegmental and segmen- tal. The nonsegmental form, also referred to as vitiligo vulgaris, is more common and often features symmetrical patches that usu- ally increase in size over time. The segmental form has a unilat- eral distribution that may completely or partially correspond to a dermatome; this form often has a rapid onset followed by a stable course and may be more amenable to treatment. 1–3 Other types of leukoderma include post-burn leukoderma, piebaldism, chemical leukoderma, drug-induced leukoderma, melanoma-associated leukoderma, and halo nevi. 5–10 Although the clinical presentation and pathogenic factors leading to these leukodermas differ, all are similarly characterized by areas of depigmentation occurring secondary to altered melanocyte activity. Current therapies for vitiligo and other leukodermas include both medical and surgical options. Medical treatments include phototherapy (e.g. narrow-band ultraviolet B [NBUVB] radiation), ª 2018 The International Society of Dermatology International Journal of Dermatology 2018 1