Surgical Therapy for Vitiligo: When And How?

Surgical therapy for vitiligo: when and how? 

Key points 

Surgical therapy is usually introduced when medical or physical treatments of vitiligo fail. 

It consists in bringing melanocytes from pigmented skin area onto white patches of the same subject. 

Many different treatments are available including simple skin punch grafting, split thickness grafting, blistering  roof grafting and the most sophisticated melanocytes or keratinocytes-melanocytes suspensions. 

The graft failure, scarring, infection, irregular pigmentation, cobble stoning appearance and vitiligo  kobnerization phenomenon are always possible and limit the use of surgery in vitiligo. 

Answer 

The surgical option in vitiligo is always  possible, at least on selected/ limited  depigmented areas. 

Two main conditions are required: 

— the white vitiligo lesion to be treated should  be stable (i.e. avoid surgical procedures in lesions  which are progressing – no progression of lesions  or appearance of additional depigmentation must  be evident for at least 2 years). 

— the white area should be recalcitrant to the  main and most effective medical and  physiotherapeutic UV-based treatments (lights or  lasers). 

A number of surgical procedures are possible. 

Among these are the following: 

— punch grafting and mini-grafting 

— epidermal grafting 

— dermo-epidermal grafting 

— suction blisters grafting

— autologous melanocyte suspension  transplant 

— treatments with tissue - engineered skin 

— cultured epidermis with melanocyte 

They are considered to be the most popular  procedures. 

Neo-melanogenesis usually begins shortly after  melanocyte graftings or transplantation and  continues for a few months at a slow rate. 

UV exposure (with lamps or natural sunlight)  induces faster and deeper repigmentation after  surgery. Surgical techniques offer repigmentation  that is not often comparable with normally  pigmented skin. They are always invasive  procedures. Final results vary considerably from  patient to patient. 

The psychological aspect of the subject who  requires surgical/invasive procedure must be  always evaluated and patient’s expectations must  be clearly discussed. 

Thus, the decision of starting a surgical  procedure for vitiligo must be always a well  balanced and informed decision.