Surgical Management of Vitiligo (original) (raw)
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Updates in Surgical Treatment of Vitiligo
Journal of Recent Advances in Medicine
Background: Vitiligo is a common cutaneous disorder of depigmentation. Surgical treatment of vitiligo is considered the final resort of repigmentation in lesions failing to respond for various medical and light therapies. The tissue and cellular graft techniques are used for the successful introduction of melanocytes into the vitiligo lesions. Stability of vitiligo is the cornerstone of evaluation before surgery. Tissue graft includes various techniques of transferring the healthy pigmented skin as a whole without processing to the vitiliginous skin, while the cellular graft involves further processing of these grafts into cellular components which are then applied on the recipient site after dermabrasion either as such or after multiplication in culture media. Aim: To outline current modalities for surgical treatment of vitiligo. Conclusion: Preparation of recipient-site is considered a crucial step for achieving a successful repigmentation. Multiple promising surgical modalities for vitiligo are continuous in the ongoing research and clinical trials to improve the repigmentation outcomes cosmetically with decreasing the time and the cost.
Multimodal Single-Step Vitiligo Surgery: A Novel Approach
Dermatologic Surgery, 2010
V itiligo is a common acquired disease affecting 1% to 2% of the population. Localized or generalized areas of the skin completely lack pigmentation and thus cause immense psychological distress. 1 This is especially of importance in darkly pigmented Asian skin. The surgical approach to the treatment of vitiligo patches depends on the need for surgery, the timing of surgery, the sites involved, the modality used, and the expectations of the patient. It has been suggested that patients should initially attempt medical therapy before undergoing surgical management, but the length of time that they should try medical therapy has not been clearly defined. Surgery should be attempted only in stable vitiligo; which has been defined as the absence of new lesions, no extension of old lesions, and the absence of the Koebner phenomenon. 2 This duration of stability has been defined from a period ranging from 4 months to 2 years in various studies. 3
Guidelines for the management of vitiligo
2016
Vitiligo is an acquired disorder of depigmentation affecting 0.1%-2% of the world’s population without discrimination of race, age and gender. The disease is characterized by white patches, often symmetrically distributed, which usually increase in size with time, corresponding to a considerable loss of functioning epidermal and sometimes hair follicle melanocyte. There are many treatment options available for the disease. Standardized guidelines for treating this disease in Asian skin are not readily available which leads to no set criteria for treating this cosmetically disfiguring problem. These guidelines have been prepared for dermatologists considering all the latest evidence based data available. Vitiligo is diagnosed clinically, although in some cases biopsy is required. Lesions on face and neck respond well to the treatment. However, segmental and acral types respond poorly to treatment. In the assessment of patient before starting therapy it is important to consider age, p...
Nonsurgical Repigmentation Therapies in Vitiligo
Archives of Dermatology, 1998
To assess the effectiveness and safety of nonsurgical repigmentation therapies in localized and generalized vitiligo by means of a meta-analysis. Data Sources: Computerized searches of bibliographic databases, a complementary manual literature search, and contacts with researchers and pharmaceutical firms. Study Selection: Predefined selection criteria were applied to both randomized and nonrandomized controlled trials. Data Extraction: Two investigators independently assessed the articles for inclusion. When there was a disagreement, a third investigator was consulted. Data Synthesis: Sixty-three studies were found on therapies for localized vitiligo. Of these, 10 of 11 randomized controlled trials and 29 of 110 patient series were included. One hundred seventeen studies on therapies for generalized vitiligo were found. Of these, 10 of 22 randomized controlled trials and 46 of 231 patient series were included. Among randomized controlled trials on localized vitiligo, the pooled odds ratio vs placebo was significant for topical class 3 corticosteroids (14.32; 95% confidence interval [CI], 2.45-83.72). In the patient series, topical class 3 and class 4 corticosteroids carried the highest mean success rates (56% [95% CI, 50%-62%] and 55% [95% CI, 49%-61%], respectively). Side effects were reported mostly with topical psoralen and intralesional and class 4 corticosteroids. In the randomized controlled trials on generalized vitiligo, the odds ratio vs placebo was significant for oral methoxsalen plus sunlight (23.37; 95% CI, 1.33-409.93), oral psoralen plus sunlight (19.87; 95% CI, 2.37-166.32), and oral trioxsalen plus sunlight (3.75; 95% CI, 1.24-11.29). In the series, the highest mean success rates were achieved with narrowband UV-B (63%; 95% CI, 50%-76%), broadband UV-B (57%; 95% CI, 29%-82%), and oral methoxsalen plus UV-A therapy (51%; 95% CI, 46%-56%). Oral methoxsalen plus UV-A was associated with the highest rates of side effects. No side effects were reported with UV-B therapy. Conclusions: Class 3 corticosteroids and UV-B therapy are the most effective and safest therapies for localized and for generalized vitiligo, respectively.
International Journal of Dermatology, 2020
Background Despite advances in surgical management of vitiligo, lesions on acral areas and bony prominences remain treatment refractory. There is lack of literature on the treatment efficacy of various surgical modalities over these treatment refractory sites. Objective To compare the efficacy of three common methods of grafting in vitiligo in known resistant areas. Methods A single-center interventional clinical trial involving 30 patients of stable vitiligo (disease stability ≥1 year) located over bony prominences and acral areas. All patients were treated with noncultured epidermal cell suspension (NCES), suction blister epidermal grafting (SBEG), and mini punch grafting (MPG) on three separate patches. Extent of repigmentation was assessed at 12 and 24 weeks, color matching and patient satisfaction were evaluated at 24 weeks. Results Among 30 participants, 22 (73%) were females, mean age was 27.4 (AE10.7) years, and the majority (93.3%) had nonsegmental vitiligo. At 12 weeks, repigmentation >75% was noted in 56.6, 60, and 16.6% of patches treated by NCES, SBEG, and MPG, respectively. At 24 weeks, results remained the same in both the NCES and SBEG groups, while the number of patches with >75% repigmentation increased to 23.3% in the MPG group. The difference in repigmentation rate between NCES and MPG as well as between SBEG and MPG achieved statistical significance. Color matching of treated area and patient satisfaction were better in NCES and SBEG groups compared to MPG. Conclusion NCES and SBEG are superior to MPG with reasonably good efficacy and can be offered as a therapeutic modality for stable vitiligo patches over these sites.
Consensus on the treatment of vitiligo – Brazilian Society of Dermatology
Anais Brasileiros de Dermatologia, 2020
Background: Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives: The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods: Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Tw o experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus.
An Overview on the Epidemiology, Pathophysiology and Treatment of Vitiligo: A Review
Journal of Pharmaceutical Research International, 2021
Vitiligo is one of the complex diseases that has existed during the entire history of humanity and so far we have not fully understood it, serval theories have been proposed most of them suggest strong linkage between deficiencies in certain genes and the disease, refereeing that the disease has strong genetic factor that plays a rule in triggering the disease, and the epidemiology studies confirms also that theory due to higher incidence in people who have siblings but this theory does not fully unlocks the full causes of the disease as it seems also to have strong environmental triggers. One of the biggest problem about the disease and the QoL is not the disease lifestyle itself but rather the social and psychological effects of the disease and the social acceptance impact, because it affects the appearance of its patients and thus affects their social acceptance leading to some serious psychological and depressive disorders, and that effects differs from society to another and by...
Repigmentation in vitiligo: position paper of the Vitiligo Global Issues Consensus Conference
Pigment Cell & Melanoma Research, 2017
The Vitiligo Global Issues Consensus Conference (VGICC), through an international e-Delphi consensus, concluded that "repigmentation" and "maintenance of gained repigmentation" are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation and the second summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over three years. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus. SIGNIFICANCE There is a need to clearly describe and define the various aspects of vitiligo repigmentation. The discussions at international meetings and e-surveys have sought to address both the issues of repigmentation and the maintenance of gained repigmentation.
Vitiligo - Part 2 - classification, histopathology and treatment
Anais Brasileiros de Dermatologia, 2014
In an unprecedented effort in the field of vitiligo, a global consensus resulted on a suggested new classification protocol for the disease. The main histopathological finding in vitiligo is the total absence of functioning melanocytes in the lesions, while the inflammatory cells most commonly found on the edges of the lesions are CD4+ and CD8+ T lymphocytes. Physical and pharmacological treatment strategies aim to control the autoimmune damage and stimulate melanocyte migration from the unaffected edges of lesions and the outer hair follicle root sheath to the affected skin; moreover, surgical treatments can be combined with topical and physical treatments.