Guidelines for the Management of Vitiligo

The European Dermatology Forum Consensus

A. Taieb; A. Alomar; M. Böhm; M.L. Dell'Anna; A. De Pase; V. Eleftheriadou; K. Ezzedine; Y. Gauthier; D.J. Gawkrodger; T. Jouary; G. Leone; S. Moretti; L. Nieuweboer-Krobotova; M.J. Olsson; D. Parsad; T. Passeron; A. Tanew; W. van der Veen; N. van Geel; M. Whitton; A. Wolkerstorfer; M. Picardo

Disclosures

The British Journal of Dermatology. 2013;168(1):5-19. 

In This Article

Surgery

Surgical procedures aim to replace the melanocytes with ones from a normally pigmented autologous donor site. Several melanocyte transplantation techniques can be performed under local anaesthesia in an outpatient facility. However, transplantation for extensive areas may require general anaesthesia. All methods require strict sterile conditions.[92–99]

Punch grafting (tissue graft) is the easiest and least expensive method, but it is not suitable for large lesions and seldom produces even repigmentation.

Epidermal blister grafting gives excellent cosmetic results, but it is time-consuming, and large areas cannot be treated.

Ultrathin epidermal sheet grafting can treat larger areas (up to 200 cm2) but requires skill and experience.

Cellular grafts consist of a basal cell layer autologous suspension containing melanocytes and keratinocytes. A given area can be treated with a good donor to recipient ratio. Initially, this procedure required a laboratory facility for cell processing, but single-use kits for enzymatic separation of thin shave biopsies from the graft area have been developed, allowing the generation of cell suspension in the operating room within 1 h.

Transplants of pure cultured melanocytes expanded in vitro can treat lesions up to 500 cm2. This method is more expensive, time-consuming and requires specialized staff.

The highest incidence of adverse events occurs with punch grafting (scar formation at the donor site, cobblestoning of the acceptor area) followed by ultrathin epidermal grafting (transient or permanent hypopigmentation, hypertrophic scars on the donor site, milia formation on the recipient site) and suction blister epidermal grafting (transitory hyperpigmentation on donor site, imperfect colour matching on the recipient site).[95] Rare side-effects (temporary depigmentation at donor site and transitory inflammatory hyperpigmentation at recipient site) have been observed with cellular grafting. Follow-up studies have documented long-term stability and safety.[94]

Although surgery is normally indicated for all types of stable vitiligo, only a small number of patients with vitiligo are suitable. The best indications are stabilized segmental or focal vitiligo, mainly when SV is characterized by leucotrichia and large lesional areas.[99] In NSV various recommendations suggest a period of disease inactivity ranging from 6 months to 2 years, and no history of a Koebner isomorphic response. No consensus exists concerning the minimal age for surgery, which is generally performed under local anaesthesia.[92,95–97] It has to be stressed that surgery does not change the overall prognosis of the disease in the case of NSV. When a surgical treatment is conducted in NSV it should be combined with other medical and or UV-light treatment for best outcome and long-term stability.

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