Advanced Treatment Modalities for Vitiligo

Abstract

Our ability to treat vitiligo may be imperfect, but through appropriate patient selection and careful application of one or more of these advanced therapies, successful treatment of vitiligo, even in patients refractory to treatment, can be achieved.

Surgical management of vitiligo - An approach to the patient

“…The recipient site is also prepared by taking multiple punch biopsies that are the same size or 0.25 to 0.5 mm smaller than those taken from the donor site. 18 Most of the authors prefer the use of similar size of punch grafts from both the sites. The grafted tissue from the donor site is then secured into the vitiliginous areas.…”

“…Thus it has been proposed that 1.5 mm should be the upper size limit for punch grafts on the trunk or extremities and 1 mm on the face. 18,23 Lahiri and Sengupta suggested that a resistant cobblestoning may be corrected with electrofulguration. 24 Agarwal et al(1999) used silicone gel sheet dressings for prevention of post minigraft cobblestoning.…”

“…Koebnerization, keloid formation and scarring are the complications seen at the donor site. 18 Most of these complications can be avoided by proper selection of patients.…”

“…Post op PUVA, PUVASOL or UVB (especially narrow-band UVB) therapy have been shown to improve repigmentation and can be initiated as soon as the site is reepitheliazed. 18 …”

Vitiligo: characterization of melanocytes in repigmented skin after punch grafting

“…Among these surgical approaches, punch grafting represents a simple and effective procedure, which involves performing multiple perforations in the recipient depigmented site using biopsy punches and transplanting similar size punches harvested from a normally pigmented donor site. [3][4][5][6] Additional treatments such as narrow band ultraviolet B (NB-UVB), psoralen plus ultraviolet A (PUVA)/khellin plus ultraviolet A (KUVA) or topical corticosteroids following the grafting can further promote the pigmentation process. These therapies aim at repigmenting the lesional skin and stimulating the melanocyte activation, proliferation and migration.…”