Category : Dermatology
Vitiligo is a pigmentary skin disorder characterised by white patches. It occurs due to various reasons leading to melanocyte destruction. Melanocytes are the cells which produce melanin pigment, giving the skin it’s natural colour.
There are various treatments available for vitiligo. From creams to tablets, phototherapy and surgical methods. The choice of the treatment depends on the type and site of vitiligo.
For localised patches- creams , sun exposure,phototherapy is usually advised. For a patient who is developing fresh patches I.e, unstable type of vitiligo, a combination of creams , tablets and phototherapy are advised.
At times vitiligo remains stable without developing any new patch and without increase in the size of the existing patch. Such stable vitiligo patches are best suited for surgery , if the re-pigmentation is not adequately achieved in medical modalities .
Conventional medical treatments (topical and systemic corticosteroids, immunomodulators) and physical therapies (phototherapy) are effective only in 50–60% of cases.
Certain areas such as acral, bony and nonhairy areas are resistant to these treatments. Surgical treatment is useful in such resistant areas and residual lesions.
There are various methods of vitiligo surgeries . The basic principle is to introduce melanocytes into the affected skin, which will then establish to produce normal pigment.
For any surgical method to yield good results, proper selection of cases is of paramount importance. Stability of vitiligo is considered as the most important parameter while opting for any surgical technique to treat vitiligo.
The appropriate surgical method is chosen taking different factors in to consideration: area affected, age of patient, patients’ requirements, facility available, expertise of the surgeon and cost of surgery.
Vitiligo surgeries can be divided into tissue grafts and cellular grafts
Tissue grafts- Among all the techniques described for surgical management of vitiligo, mini punch grafting is the easiest and minimal expensive technique. In this procedure small bits of skin , from patients own normal pigmented area like thigh, are taken using disposable punches of 1-2mm . The grafts are then placed on the vitiligo site . Post op phototherapy or sun exposure is advised. The pigment spread starts from the grafted area to the vitiligo patch producing pigmentation in 3-6 months . This method is preferable for patches on hands , feet specially fingers
Another method of tissue grafts is Suction blister graft. This is a method in which superficial layer of skin is seperated by prolonged suction at a negative pressure to donor site followed by transplanting the roof of the blister to the dermabraded vitiliginous recipient site. The melanocyte transfer takes place and repigmentation usually complete within 3 months. This method is preferred for lips and eyelids.
Compared to tissue grafts, cellular grafts are more advanced and provides better color match. The most used technique is Non cultured melanocyte suspension. Here the melanocytes are procured from the skin obtained from the patient s normal looking areas. This is an advanced procedure requiring skill, reagents and infrastructure. The vital steps include donor harvesting, trypsinization to separate the cells, antitrypsinization to remove excess trypsin, centrifugation to make a suspension of cells which is then transferred to recipient area. The color match obtained is better than the tissue grafts. This method is suitable for any area.
All the above said procedures are performed as day- care procedures at affordable cost at JSS hospital. Patients with vitiligo can avail the facility by consulting the Dermatologists at JSSH. Depending on the type and site of vitiligo the most suitable method of grafting will be performed. JSSH is equipped with the state of art phototherapy unit which can be utilised by patients post grafting for better pigmentation of the area.