What is Vitiligo?
Vitiligo is a chronic skin disorder that causes areas of skin to lose colour. It presents as depigmented (white) patches. Exposed body sites, such as the face, elbows, knees, hands and feet, are often involved, resulting in significant cosmetic concerns. Vitiligo is usually treated with creams and tablets, or by phototherapy. Vitiligo may fail to improve or clear with these treatments.
Surgical treatment options can be considered in patients with stable vitiligo.
What are the different types of vitiligo surgery?
All types of surgical treatment aim to transfer melanocytes (pigment-producing cells) from normal skin (the donor site) to the skin affected by vitiligo.
Surgical treatment for vitiligo can be considered in two main categories:
- Grafting of melanocyte-rich tissue (tissue grafting)
- Grafting of melanocyte cells (cellular grafting).
Vitiligo is also known as ‘leucoderma’. In India , it is called ‘safed kod’ or ‘safed dag’ and is considered as a social stigma. Vitiligo is appearance of single or multiple depigmented patches on any part of the body.These patches gradually increase in size & cause lot of psychological stress in the patient. It is an auto-immune condition and may have a genetic predisposition. Treatment of vitiligo usually takes a long time. Medical treatment helps arrest the spread of depigmentation and in some cases, may bring back the pigmentation. In majority of the cases, medical therapy only achieves stabilization of the vitiligo patch but fails to cause repigmentation. However, repigmentation in cases of ‘stable vitiligo’ can be achieved by various dermatosurgical techniques.
PUVA therapy enhances skin re-pigmentation. An oral psoralen compound is given to the patient. Two hours later , the de-pigmented patch on his body is exposed to ultraviolet-A (UVA) rays, for a fixed time duration. This should be supervised by a medical personnel. If UVA is not available then the patch is exposed to sun rays. The latter is known as PUVA SOL therapy.Treatment with UVB rays is another option. The most recent modality is treatment with Excimer laser.
When the de-pigmented patch does not increase in size for a period of two years, it is said to be stable. This is the right time to perform vitiligo surgery. If the patch is growing or is in an active phase, it needs treatment with medicines and / or PUVA till it stops growing.
Method to be used depends on the type and site of lesion. Hence, selection of the appropriate surgical technique is important for good cosmetic results.
- Miniature punch grafting.
- Ultra thin skin grafting.
- Suction blister grafting.
- Therapeutic spot or regional dermabrasion .
- Melanocyte culture and transplantation.