5.11 Vitiligo/leukoderma: (Surgical Techniques)

The vitiligo or whitish patches on the skin is considered as a social stigma. So, this condition causes lot of stress in patients. Vitiligo is an autoimmune condition having genetic predisposition.

Vitiligo mean a patch on the skin where melanin or dark pigment is absent. So the patch appears white. The patch can be of small in size or slowly it may involve multiple parts of the body. Unstable vitiligo: Unstable vitiligo increases in size, shows appearance of new lesion and has ill-defined margins. There are various types of ways of presentation of vitiligo. Focal vitiligo is small & is limited in particular part of the body so it has good prognosis. Vitiligo vulgaris has several patches. It has fair prognosis. Segmental vitiligo has no satisfactory prognosis. Acrofacial and universal vitiligo has poor prognosis. Indicators of poor prognosis are lesion on prominent and bony part, lesion on palm and sole, nipple and areola.

Active vitiligo is first treated withPUVA is therapy of enhancing skin repigmentation. Orally psoralen tablet is given two hours later the patch is exposed to ultraviolet (PUVA) rays for a fixed duration. When UVA is not available patch is exposed to sun rays (PUVA SUL). Treatment with narrow band UVB can also be done. Excime laser and excimer light may also be used. Such medical treatment is done to stabilize growing white patch. When patch stops growing it is called as stable vitiligo. After 1 to 2 year such stable vitiligo can be treated by surgery.

Plastic or cosmetic surgery on the stable patch of vitiligo: Any stable patch of vitiligo means it remains of the same size & shape at least for 2 year.

If patch of vitiligo is stable for 1 to 2 year then cosmetic plastic surgery can be done. There are various ways of skin grafting to eradicate white patch.

These are as follow:

  • Skin grafting: This is good method of eradicating white patch on the skin.
  • Punch skin grafting: This is less skillful procedure. It take some time to achieve results. Small circular patches (punched pieces) of skin are removed & grafted on the white patch. Slowly the pigment of the graft spreads in surrounding area. They need additional PUVA therapy.
  • Blister method:It is similar to skin grafting. Skin for grafting is removed by producing blister with the help of vaccum.
  • Non cultured melonocyte transfer:To cover big sized area, epidermis of skin graft is separated. The melanocytes from such processed graft tissue are transplanted on the vitiligo patch. It is costlier procedure.
  • Cultured melanocyte transfer:When vitiligo patches are extensive.The melanocyte patches of the cells from normal skin grafts are removed & cultured. These cultured cells are transferred on ablated white patch. This method covers larger area. So it is costlier procedure.
  • Tattoing:Artificial pigment is injected into depigmented areas. Matching pigment shade is selected. With the help of manually or electrically driven needles pigment granules are implanted into leucoderma patch. After 1-2 year bluish hue ad develop at this site which may be unacceptable by beneficially. So, this procedure is reserved in cases where patch is in an inoperable site.

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