Question 15. Surgical therapy for vitiligo: when and how?

Key points

  • Surgical therapy is usually introduced when medical or physical treatments of vitiligo fail.
  • It consists of introducing melanocytes from pigmented skin area onto the 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 melanocyte or keratinocyte-melanocyte suspensions.
  • Graft failure, scarring, infection, irregular pigmentation, cobble stoning and the vitiligo kobnerization phenomenon are always possible and limit the use of surgery in vitiligo.

The surgical option in the treatment of 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 melanocytes

These 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 to start a surgical procedure for vitiligo must be always a well-balanced and informed decision.

Author: Prof. Torello Lotti, MD

Please be advised that all information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician or health practitioner. Users are warned against changing any aspects of their treatment, diet or lifestyle based on this information without first consulting a registered medical practitioner. While every precaution is taken to ensure accuracy, VR Foundation makes no warranty as to the reliability, accuracy, timeliness, usefulness or completeness of the content which reflect personal opinion of the authors.

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