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Postoperative considerations and adjuvant treatments
Postoperative considerations and adjuvant treatments
A variety of adjuvant therapies exist which can be used postoperatively to optimize repigmentation. Topical agents such as calcineurin inhibitors reduce immune response while avoiding the atrophy that may occur with excessive topical corticosteroid use.
Oral adjunctive therapies include antioxidants such as ginkgo biloba and alpha lipoic acid that may be possibly used to induce disease stability, since active disease is associated with impaired clearance of reactive oxygen species within affected melanocytes.60 Oral minipulse steroid (OMP) therapy can be used to promote repigmentation and induce disease stability. A study by Mulekar used betamethasone OMP therapy, given at a dose of 0.1 mg/kg body weight per week, in patients with vitiligo vulgaris and segmental vitiligo who failed to show repigmentation between 2 and 11 months following MKTP. The results showed that the majority of patients had excellent repigmentation following subsequent transplantation sessions. OMP can be associated with some side effects, such as weight gain and acne. More serious adverse events are uncommon due to the low dose and short duration of therapy.61
Postoperative irradiation using narrowband ultraviolet B (NB-UVB) is thought to have a proliferative and stimulatory effect on transplanted melanocytes,18 while stabilizing disease.62 NB-UVB can be associated with mild pruritus and erythema, but is otherwise well tolerated.63 Compared to PUVA, NB-UVB is considered more safe in adults and children with vitiligo.18,64,65 Finally, additional surgery may be necessary in areas with suboptimal results.