Surgical Treatment for Vitiligo
Dr Vivekananda Bhat
Lavelle road, Bengaluru Feb 9, 2017
Once the white patch appears and starts to spread then all patients require medical treatment to be started, this could be in the form of immuno modulators, immuno suppressives, or steriods coupled with narrow band UV therapy or Excimer laser therapy. Gone are the days of taking psoralens and exposing to sun light, with the advent of narrow band uv therapy it is possible to stimulate the melanocytes without taking any medicines using narrow band uv light or excimer laser light.
Narrow band UV light can stimulate pigmentation in hairy areas of the skin and also help to stabilize the spread of patches.
Up to 100 sittings can be given after which it is better to supervise the rest to check for skin thickening, or remote possibility of development of skin tumors.
Uv therapy is combined with one of the medicines mentioned above to try and arrest the spread of vitiligo.
Results could be in the form of
- Complete cure
- Partial cure.
- No cure but the patches stop spreading, that is unstable vitiligo becomes stable.
Duration : At least one year plus. After 1 year we can take a call whether surgical treatments can be added ,to hasten the process of pigmentation. Effects, side effects of medicines, pro and cons are discussed on a case to case basis. Pigmentation starts within a few months of starting with medical therapy if and when it starts of, as discussed before hairy areas of the body which have black hairs pigment faster than non hairy areas, which are more resistant to medical treatment.
This image shows the stimulation of Melanocyte stem cells with narrow band uv therapy ,which then migrates to the epidermis of the skin to provide color to skin.Once medical treatment proves in effective in providing pigmentation then surgery is the next logical choice, and as medical treatment is in effective in providing 100 percent pigmentation all the time surgery has evolved as an option for vitiligo.
The evolution of surgical treatment started with skin grafting, where in to replace a white patch a slightly bigger skin area was removed from the donor area-usually buttocks or thighs and then the white patch was dermabraded to remove the upper layer of the skin and this skin was used to cover the white patch.
The main disadvantage of this procedure was that huge areas cant be taken up as large areas of donor skin is not easy to remove, color matching at the site where the skin was grafted did not match with the surrounding skin color, so in short a white patch became a brown patch, it was easy to spot the difference as the skin protrudes out of the surface of the skin.
So the next step was evolution of punch grafting where in small punches of skin was used to fill in white patches and here the whole patch was not covered but small punches were grafted and then the skin was stimulated with ultra violet light or sunlight with psoralens.
The main problem here is that the punches of skin stand out of the surface and resemble a side effect called cobble stone appearance.
Cobble stone appearance after punch grafting, this can make it cosmetically very ugly when done on face.