What is Vitiligo?
Vitiligo or Progressive Melanocytopenia is a Chronic Skin Disorder that affects Immune Cells of the body causing areas of Skin to lose colour and appear as White patches. Commonly, body sites such as the Face, Hands, Elbows, Knees, and Feet are involved, resulting in significant aesthetic concerns. Vitiligo is usually treated with specific creams, tablets, or by phototherapy, but also may fail to Improve or Cure with these treatments.
Who are Affected?
It can affect males as well as females equally and all the races of the world can be affected too. The onset of Vitiligo is seen as early as in an infant or elderly too. The younger age group are usually associated with a thyroid disorder, vitamin D3 & B12 deficiency along with it.
What are Different Types of Vitiligo?
Generalized Vitiligo ; where whole body is involved.
Segmental Vitiligo ; only one part or side of the body is involved.
Acrofacial Vitiligo ; where limbs, toes, fingers, and lips are involved.
Contact Vitiligo ; pigment is lost because of an allergic reaction.
Vitiligo can also be divided into:
1. Stable Vitiligo If there are no new lesions or an increase in the size of existing lesions for 6 months to 1 year it is considered as stable vitiligo. Vitiligo in stable cases can be treated with topical treatment such as steroids, immunomodulators, calcineurin inhibitors, phototherapy, excimer laser. Surgeries such as grafting or melanocyte transplants can be done in stable conditions. Recovery from surgery takes about 4 to 7 days. The patient is asked to be careful with the transplanted and donor site. Do not wet the area. When done on lips, they are asked to take a liquid diet with the help of a straw. The review is done after 1 week to change the dressing.
2. Unstable Vitiligo If the lesions are growing in size and new lesions are appearing it is called unstable vitiligo. In unstable vitiligo oral medication with steroids and immunosuppressants is used to stabilise the disease and bring the pigmentation back.
How can Vitiligo Surgery Help?
The goal of Vitiligo Surgery is to achieve complete or near complete Repigmentation that Aesthetically matches the surrounding normal skin.
Appropriate patient selection is vital in ensuring the best outcome, as not all patients or affected sites are suitable for this Surgery. The following patient factors should be considered:
Stable disease
The age of the patient
Patient expectations
Size and location of the vitiligo patch
The proposed donor site
If any ancillary procedures needed (Hair Transplant)
What are Different Types Surgery for Vitiligo?
The aim of all surgical treatments is to transfer melanocytes (pigment-producing cells) from normal unaffected skin (donor site) to the sites affected by vitiligo .
Surgical Treatment for Vitiligo can be classified into Two Main Categories:
Tissue Grafting ; Grafting of melanocyte-rich tissue.
Cellular Grafting ; Grafting of melanocyte cells directly.
Commonly used surgical techniques for repigmentation surgery are:
A. Tissue Grafting
Miniature punch grafting (MPG)
Suction blister grafting
Split thickness skin grafting
B. Cellular Grafting
Autologous non cultured epidermal cell suspensions
Cultured melanocyte suspensions
The superficial or uppermost layer of affected skin is usually removed under local anaesthesia in an outpatient setting. Techniques to remove the skin include:
Dermabrasion
Cryotherapy
Shave biopsy
Punch biopsy
Laser therapy
The Process of Grafting of Melanocyte Cell Suspensions
Autologous non-cultured epidermal cell suspensions
Autologous non-cultured epidermal cell suspensions are gaining popularity around the world as the treatment of choice for surgical management of vitiligo. Pre-prepared kits are available.
Tissue is harvested from a donor site and is incubated with trypsin to separate the epidermis from the dermis. The melanocytes are then separated from the epidermis and made into a cell suspension that can then be transplanted onto the de-epithelialized recipient skin.
Autologous non-cultured epidermal cell suspensions allow large areas to be treated in one session using a small donor graft. They result in excellent colour matching. However the procedure is expensive and complex. Due to stringent rules regarding tissue handling in Australia and elsewhere, it is not yet widely available.
Cultured melanocyte suspensions
With cultured melanocyte suspensions, tissue is also harvested and incubated with trypsin. However, after separation of the epidermis, the melanocytes and keratinocytes are incubated in a medium containing growth factors. The cultured suspension is then transplanted on to de-epithelialized recipient skin.
Cultured melanocyte suspensions allow a large area to be treated in a single session. It uses a larger donor-to-recipient ratio than the non-cultured technique. This sophisticated technique requires a special laboratory.
What are the Contraindication for Vitiligo Surgery?
Because the progress of the disease can be difficult to predict, vitiligo surgery is absolutely contraindicated in:
Active Vitiligo.
Unstable Vitiligo.
Childhood Vitiligo.
Vitiligo surgery is performed only in Stable Disease; Vitiligo that does not progress over a period of atleast 12 months. In general, Segmental Vitiligo patches have a better surgical outcome than non-segmental Vitiligo.
What Outcome can one Expect?
Outcome usually depends on the body site where the surgery is being performed, like genitals, lips, eyelids and bony prominences which have variable outcomes. Also, it depends on several factors like
Individual disease progression
Immunogenicity
Body healing mechanisms & time
Stable vs unstable vitiligo
Base complexion of the skin
Good Post-op care
Patient Compliance
In certain cases, only the best plastic surgeons go that extra mile to perform ancillary procedures like Hair Transplants over Eyebrows, Moustache or Beard and removal of white hair over the same areas as and when needed. This gives an overall aesthetically appealing result. Dr Valluri Mukesh Krishna is one of the Best Plastic Surgeons in Hyderabad, Highly Experienced in Vitiligo Surgery and has done many Successful Procedures.