Surgical Modalities in 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 about 30 years ago, it was exclusively treated with medical therapies. Most commonly used medical therapies include topical steroids, calcineurin inhibitors, and phototherapy. Lesions on the face and neck respond the best to the medical therapies, followed by proximal extremities and trunk, while those distributed over acral parts of extremities and non-hairy areas such as 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 non-cultured and cultured melanocyte/keratinocyte suspensions obtained from trypsinizing the shaved skin biopsy sample as a source of melanocytes. Recent advances over the years have enabled the dermatologists to treat extensive areas located on many anatomic sites, 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 various types of vitiligo.