VITILIGO SURGERY

Vitiligo is a pigmentary skin disorder characterized by white patches, resulting from the destruction of melanocytes – the cells responsible for producing melanin, which gives the skin its natural colour.

Treatment of vitiligo includes topical creams, oral medications, phototherapy and surgical procedures. For localized vitiligo, treatment usually involves use of topical creams and phototherapy. For unstable vitiligo, where new patches continue to appear, a combination topical medicines, oral tablets and phototherapy is recommended.

When vitiligo remains stable, ie vitiligo that does not progress over a period of 6-12 months ( no new patches and/or existing ones not enlarging) surgical intervention can be considered.

Vitiligo surgery aims to introduce melanocytes into the depigmented skin, enabling them to establish and produce normal pigmentation. The stability of the vitiligo is the most important factor when considering surgery.

Vitiligo surgeries are of 2 types: Tissue grafts and cellular grafts

Tissue Grafts
  1. Punch Grafting

It involves taking small skin grafts from a normally pigmented area such as thigh using disposable punches. These grafts are then placed onto the vitiligo affected site. This method is suitable for treating areas like hands, feet and fingers. Re pigmentation usually occurs within 3 to 6 months.

  1. Blister Roof Grafting

In this technique, a negative pressure is applied to the donor site to create a blister, allowing the superficial skin layer to be separated. The blister roof is then transferred onto the dermabraded vitiligo affected site, facilitating melanocyte transfer. Preferred for areas like lips and eyelids. Re pigmentation occurs within 3 months.

Cellular Grafts

Compared to tissue grafts, cellular grafts are more advanced providing superior colour matching. Most widely used technique is non- cultured melanocyte suspension. This process involves multiple steps, including donor site harvesting, enzymatic separation ( trypsinization) of cells removal of excess enzymes (antitrypsinization), and centrifugation to prepare a melanocyte- rich cell suspension.

Compared to other techniques cellular grafts provide better colour uniformity and can be used for any vitiligo affected area.

Surgical Dermatology