Emerging cell-based and cell-free therapeutic strategies for vitiligo

Vitiligo is a chronic, acquired skin disorder characterized by the loss of pigmentation due to the destruction or dysfunction of melanocytes. Conventional treatments such as corticosteroids and phototherapy often produce limited and unpredictable outcomes. In recent years, novel therapeutic strategies-including both cell-based and cell-free approaches such as melanocyte transplantation, mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), stem cell secretome, and exosomes-have emerged as promising alternatives. These therapies aim to restore pigmentation by replenishing melanocytes, modulating immune responses, and mitigating oxidative stress. This review explores the mechanisms of action, clinical efficacy, and translational challenges associated with each approach. While melanocyte transplantation demonstrates the highest repigmentation success in stable cases, stem cell- and exosome-based therapies offer significant potential for personalized and long-term treatment of vitiligo.