Surgical interventions for vitiligo: an evidence-based review

Abstract

SummaryBackground Vitiligo is a disfiguring disease, characterized frequently by the presence of de-pigmented macules and/or patches. Traditional therapies are essentially medical and are most preferred by dermatologists. Surgical therapies, however, are amongst the most effective interventions for vitiligo but are limited by their invasive nature, as well as the training and expertise needed to perform specific procedures. Objectives To assess the evidence for the effectiveness, safety and applicability of the various surgical methods in the treatment of vitiligo. Methods For this systematic review of vitiligo surgical therapies, our searches included: PubMed, MEDLINE and Cochrane databases. Results We reviewed research studies reporting on split thickness skin grafts (STSG), punch/mini-graft, blister roof grafting, cultured and non-cultured cellular transplantation (MKTP). While all methods vary in their repigmentation outcomes, STSG is found to have the highest repigmentation success rate. Overall, post-operative complications included milia, scarring, cobblestone appearance or hyperpigmentation of treated areas. Conclusion This review highlights the need for more randomized controlled trials in this field, underpinned by a more standardized objective approach to the assessment of repigmentation following surgical interventions.

Optimising size and depth of punch grafts in autologous transplantation of vitiligo and piebaldism: a randomised controlled trial

“…Available techniques are split-thickness grafting, epidermal blister grafting, cultured or non-cultured melanocyte (epidermal suspension) grafting and punch grafting (3,4). The punch grafting technique is a safe, simple and cheap technique, and therefore widely available and much used (3)(4)(5)(6)(7). In punch grafting, grafts are punched out from normally pigmented donor sites and are transplanted into depigmented recipient sites from which similar punch grafts have been removed previously (8).…”

“…In punch grafting, grafts are punched out from normally pigmented donor sites and are transplanted into depigmented recipient sites from which similar punch grafts have been removed previously (8). Large grafts (>2 mm) have high risks on side effects like cobblestone formation (3,4,7,9). Hence, the current technique involves 1-to 1.5-mm superficial punch grafts, depending on anatomical location (10).…”

“…The current technique of grafting is poorly standardised and varies based on personal experience (4)(5)(6). In the past decade, clinical trials focused mainly on complex and expensive techniques, while punch grafting was neglected.…”

Appearances in clinical dermatology

“…[23] Following punch grafting for vitiligo, a "cobblestone appearance" may develop at the recipient site, a significant cosmetic complication of this technique. [24] Confetti-like appearance Confetti appearance of skin lesions have been described in many skin conditions as mentioned below Amyloidosis cutis dyschromica Primary cutaneous amyliodosis, first defined by Morishima in 1970 is a rare chronic progressive disease with deposition of amyloid in the skin without systemic involvement. It is characterized by hyperpigmented and hypopigmented spots, prepubertal onset and amyloid deposits in the papillary dermis.…”

Successful Treatment of Segmental Vitiligo in Children with the Combination of 1-mm Minigrafts and Phototherapy

“…Therefore, minigrafting using smaller grafts was then attempted. It is now thought that grafts ≥1.5 mm in size are prone to conditions such as cobblestone or polka dot appearance or scar formation as postoperative adverse effects [8,9,10]. Consequently, minigrafting using grafts of 1.0-1.2 mm in size has been widely adopted [9,10,11].…”