Surgical management of vitiligo

Abstract

Vitiligo is a common condition characterized by hypopigmented and/or depigmented spots on the skin, affecting approximately 1-2% of the world population. Until approximately 30 years ago, it was exclusively treated by medical therapies. The most commonly used medical therapies include topical steroids, calcineurin inhibitors and phototherapy. Lesions on the face and neck respond the best to medical therapies, followed by lesions on the proximal extremities and trunk, while those distributed over acral parts of extremities and nonhairy areas, such as the wrist, feet and male genitals, respond poorly. Surgical methods complement medical therapies by providing melanocytes to these refractory lesions, and are indicated for unilateral segmental and clinically stable bilateral vitiligo, refractory to medical treatment. Tissue-grafting methods include minigrafting or punch grafting, epidermal grafting and split thickness grafting. These methods use full-thickness punch grafts, roof of epidermal blisters and shave biopsy samples, respectively, as the source of melanocytes. Cellular grafting includes noncultured and cultured melanocytes/keratinocytes suspensions obtained from trypsinizing the shaved skin biopsy sample as a source of melanocytes. Recent advances over the years have enabled dermatologists to treat extensive areas located on any anatomic site in a single operative session by surgical intervention. The purpose of this review is to describe the selection criteria for the surgical treatment, their utility and limitations in the various types of vitiligo.

Efficacy and safety of automated epidermal micrograft in patients with stable segmental and nonsegmental vitiligo

“…95.5% of the patients achieved repigmentation after grafting, and 39.28% of all patients achieved good or very good repigmentation. The results are consistent with those of previous studies 14 . In other published studies, lesions on the face and neck have shown excellent improvement with repigmentation in patients with stable vitiligo who underwent noncultured cell grafts and SEBG grafting 15,16 .…”

“…The results are consistent with those of previous studies. 14 In other published studies, lesions on the face and neck have shown excellent improvement with repigmentation in patients with stable vitiligo who underwent noncultured cell grafts and SEBG grafting. 15,16 Notably, due to micrograft displacement risk on the neck and other mobile areas, proper fixation of grafts is essential for successful grafting.…”

The effect of NB‐UVB on noncultured melanocyte and keratinocyte transplantation in treatment of generalized vitiligo using two different donor‐to‐recipient ratios

“…Lastly, 38.1% of the patients were of skin type II. Mulekar stated that skin type II shows worse results than types III‐VI due to its poor ability to tan.…”

Combination of epidermal keratinocyte–melanocyte cells suspension and microneedling: Safe surgical approach in vitiligo

“…But, a suspension of epidermal cells, epithelial transplantations, and cultured melanocytes are used in the newer cell‐based method, which was observed to have the advantage in skin epidermal cells over tissue in increasing therapeutic efficacy 11,12 . Moreover, the complications of using this method are acceptable and follow‐ups were associated with very good therapeutic responses at different levels 13,14 . Findings showed that in this method, the transfer of melanocyte cells from the healthy area to the lesion area has been successful and natural melanocytes of the epidermis are effective to increase the skin opacity of the lesion area by creating differentiation and production of melanin in new cells 15 .…”