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Introduction
CHAPTER 52 Vitiligo
Amanda F. Nahhas Tasneem F. Mohammad Iltefat H. Hamzavi
SUMMARY
Vitiligo surgery is an effective treatment modality in patients with stable disease
who have failed medical management (except for focal and segmental vitiligo, in which surgery is a first-line option), and do not have perioral or distal fingertip involvement.
Surgical techniques in vitiligo are broadly classified as either tissue or cellular
grafts.
Beginner Tips
Indicators of a favorable response include stable disease, focal and segmental vitiligo,
and facial, neck, and truncal involvement.
Indicators of an unfavorable response include unstable disease, nonsegmental vitiligo,
isolated scalp leukotrichia, and lesions affecting the extremities, distal fingertips, periorificial areas, and joints.
STSG is the most effective surgical technique for establishing repigmentation in small
patches of vitiligo, but it does have limitations.
Expert Tips
For larger patches of vitiligo, NCES is the most effective treatment option, with the
largest number of supporting clinical trials available.
Adjuvant treatments such as topical immunomodulators, oral corticosteroids, oral
antioxidants, phototherapy, and additional surgeries may be necessary after vitiligo surgery to optimize treatment outcomes.
Donโt Forget!
The size and location of the surgical site, clinical resources, and the risks and benefits
of each method should be carefully considered when selecting a surgical technique.
The Q-switched ruby laser, Q-switched alexandrite laser, and Q-switched Nd:YAG
laser are effective modalities for laser-mediated depigmentation in vitiligo.
Pitfalls and Cautions
Micropigmentation is generally not recommended for camouflage due to associated
long-term complications.
All techniques involve possible risks of undesirable scarring, textural mismatch, and
color mismatch.
These techniques should be used only with extreme caution in patients with a history of
keloid formation.
Patient Education Points
Preoperatively, patients must understand that it may take months to years to achieve the
full extent of repigmentation and color match, and that surgery is a treatment, not a cure for the disease.
Billing Pearls
Although it has been shown to improve quality of life, vitiligo surgery is currently not
covered by insurance in the United States, making it unavailable to many patients.
CHAPTER 52 Vitiligo
INTRODUCTION
Vitiligo is characterized by the development of depigmented macules and patches, and occurs through the mechanism of melanocyte destruction. Treatment focuses on repigmentation and disease stabilization using medical, light-based, and surgical therapies; though each of these approaches may be used independently, combination approaches are frequently utilized to optimize outcomes.
Surgical approaches are effective for select patients with vitiligo. Existing techniques in vitiligo surgery have undergone significant refinement and continue to evolve, with a focus on optimizing treatment outcomes as well as physician and patient satisfaction. Though relatively underperformed, vitiligo surgery has become increasingly popular due to the limitations of medical therapies for vitiligo.