Surgical Management of Stable Vitiligo: A Review with Personal Experience

Mutalik, Sharad; Ginzburg, A.

doi:10.1046/j.1524-4725.2000.09182.x

Cited by 70 publications

(89 citation statements)

References 34 publications

(53 reference statements)

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“…The period for which these criteria are applied ranges from 6 months to 3 years, depending upon the experience of the treating surgeon. [7][8][9]41 In the absence of any rigorous studies and objective tests, these criteria are entirely subjective and sometimes unreliable. An absolute contraindication for surgical treatment is the predisposition to formation of keloid and/or hypertrophic scars.…”

Section: Discussionmentioning

confidence: 99%

Surgical interventions for vitiligo: an evidence-based review

Mulekar¹,

Isedeh

2013

Br J Dermatol

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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.

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Section: Discussionmentioning

confidence: 99%

Surgical interventions for vitiligo: an evidence-based review

Mulekar¹,

Isedeh

2013

Br J Dermatol

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“…It has also shown effective results in treatment of vitiliginous areas with leukotrichia. 13 Cobblestoning, depigmentation and scarring has not been seen. It is a relatively easy and safe procedure.…”

Section: Advantagesmentioning

confidence: 98%

“…13 Various surgical modalities of treatment for vitiligo have been described (Table 4). These are being discussed in detail in this article.…”

Section: Classificationmentioning

confidence: 99%

“…Initially the color may appear a bit darker due to ecchymosis but the skin color matches within 6-8 weeks. 13 …”

Section: Njdvl -9mentioning

confidence: 99%

“…9 It is performed with the use of 1mm, 1.5mm, 2mm or 2.5mm punches. 13 Grafts are taken from a normally pigmented donor site of similar thickness and adnexal makeup to the recipient vitiliginous site. 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.…”

Section: Punch Graftingmentioning

confidence: 99%

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Surgical management of vitiligo - An approach to the patient

Manchanda

Bansal

Pandey

2013

Nepal J Dermatol Venereol & Leprol

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Vitiligo vulgaris is an acquired chronic pigmentary disorder with an average world wide incidence of approximately 1%. Clinical classification of vitiligo is based on the distribution and extension of lesions as localized, generalized, and universal. As vitiligo has great psychosocial implications especially in dark-skinned individuals, treatment should begin early. Currrent modalities of treatment include medical therapy, surgical modalities and laser. Medical treatment options include topical corticosteroids, calcineurin inhibitors, vitamin-D derivatives, phototherapy (ultraviolet A [UVA], narrowband UVB), photochemotherapy (psoralen plus UVA [PUVA]. Surgical methods used in the management of vitiligo gave cosmetically acceptable results in short periods. Successful treatment with various surgical techniques requires an appropriate selection of patients mainly focusing upon the stability of the clinical disease. The choice of the procedure always depends upon the age, the area involved, site and the cosmetic need of the patient. The nature of the procedure, expected outcome and the complications should be discussed with the patient in detail. This article mainly deals with various dermatosurgical approaches in brief available till date for the treatment of vitiligo.

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Erbium:YAG Laser and Cultured Epidermis in the Surgical Therapy of Stable Vitiligo

Guerra¹,

Primavera²,

Raskovic³

et al. 2003

Arch Dermatol

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To induce complete and reproducible repigmentation of large "stable" vitiligo lesions by means of autologous cultured epidermal grafts using a rapid, simple, and minimally invasive surgical procedure.Design: Achromic epidermis was removed by means of appropriately settled erbium:YAG laser, and autologous epidermal grafts were applied onto the recipient bed. Melanocyte content was evaluated by dopa reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system.Setting: A biosafety level 3-type cell culture facility, a surgical ambulatory department, and a dermatological department in a hospital.Patients: Twenty-one patients with different types of vitiligo were admitted to the study and treated with autologous cultured epidermal grafts. Inclusion criteria were failure of at least 2 standard medical approaches; no therapy for at least 12 months; no progression of old lesions or appearance of new lesions; no Koebner phenomenon within the past 18 months; and no autoimmune disorders. Results:The average percentage of repigmentation in 21 patients was 75.9% (1759.7 cm 2 repigmented/2315.8 cm 2 transplanted). Three patients showed a reactivation of their vitiligo and did not show repigmentation. The remaining 18 patients, with 43 distinct lesions, showed an average percentage of repigmentation of 90% (1759.7 cm 2 repigmented/1953.4 cm 2 transplanted).Conclusions: Under appropriate conditions, cultured epidermal grafts induce complete repigmentation of stable vitiligo lesions. Erbium:YAG laser surgery can supply a fast and precise tool for disepithelialization, hence allowing treatment of large vitiligo lesions during a single surgical operation.

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Surgical Management of Stable Vitiligo: A Review with Personal Experience

Abstract: Although the retrospective nature of this article limits its validity, discussing the various therapeutic options is of value as continuing medical education. Surgical treatment may be individualized to obtain the best possible cosmetic result.

Cited by 70 publications

References 34 publications

Surgical interventions for vitiligo: an evidence-based review

Surgical interventions for vitiligo: an evidence-based review

Surgical management of vitiligo - An approach to the patient

Erbium:YAG Laser and Cultured Epidermis in the Surgical Therapy of Stable Vitiligo

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