Vitiligo is also known as ‘leucoderma’. In India, it is called ‘safed kod’ or ‘safed dag’ and is considered as a social stigma. Vitiligo is appearance of single or multiple depigmented/white patches on any part of the body.These patches gradually increase in size & cause lot of psychological stress in the patient. Treatment of leucoderma usually takes a long time. Often we come across vitiligo patients who have stop responding to all possible medical therapies or who are responding very slowly to the same. Repigmentation in such recalcitrant cases of ‘stable vitiligo’ can be achieved by various dermatosurgical technique.
Apart from these, smaller group of secondary leucodermas (following thermal or chemical burns, etc) also need correction of the depigmented lesions.
Indication for surgery and patient selection
1) Surgery is indicated for all types of stable vitiligo and secondary leucoderma that do not respond to medical treatment.
2) Vitiligo lesions should be strictly stable for last two years (minimum six months) i.e. existing lesions should not be expanding and no new lesion should have appeared in the interim.
If the patch is growing or is in an active phase, it needs treatment with medicines and / or PUVA till it stops growing.
Methods of surgical modalities
The choice of surgical intervention is individualized according to the type of vitiligo, stability, localization of lesions and cost-effectiveness of the procedure.
1) Punch grafting
Multiple thin grafts of 1-3 mm diameter are harvested from the unaffected skin site by special punches and then grafted over the affected vitiligo area. Donor grafts are taken from thighs, buttocks or hips. For facial grafting the grafts are usually taken from behind the ear. Dressing is done. Grafts are taken up in 7-10 days after which phototherapy and topical medications are started. Re pigmentation occurs in 3 – 6 months and the vitiligo area gradually develop normal skin colour. The donor and recipient sites look their best after 6 months.
Complications can include scarring, cobble-stoning, infection, incomplete color and/or mismatched color, and hyperpigmentation.
2) Suction blister epidermal grafting
This procedure consist of obtaining very thin skin grafts by applying prolonged suction (negative pressure) to the donor site. This raises a large bleb in 2-3 hours and a thin graft containing only the epidermis is obtained. This is grafted on to the dermabraded recipient surface. This technique is time consuming but gives excellent cosmetic results as the graft is very thin. This technique is best for lips and eyelids.
3) Autologous melanocyte transplantation
In this procedure, a shave biopsy sample of skin is taken with a dermatome from unaffected site. The skin sample is processed to obtain a cellular suspension of melanocytes and keratinocytes which is transplanted on the denuded recipient site. The area is covered with a collagen dressing and immobilized.Fairly large areas can be treated with this method and excellent cosmetic results obtained.
4) Cosmetic Camouflage
Highly pigmenteg creams designed to cover and correct skin discoloutation and tatoos. The colours are waterproof and last even in conditions like sweating and swimming. After selecting the pigment shade which matches the surrounding skin color, the colour is applied onto the depigmented patch, followed by fixing powder and spray. the intermixable skin tones allow a natural appearance.