Vitiligo is a common depigmenting disorder which occurs due to absence or near absence of melanin producing cells (melanocytes) in the skin. The presence of a white patch anywhere on the skin causes social stigma. The various medical treatments available are in the form of creams, ointments, tablets, phototherapy. They give good results with prolonged use. Some of the patches may not respond to these conventional therapies.
This is where surgical treatment in the form of skin grafting acts like a boon. The objective of surgical treatment is to give cosmetically acceptable repigmentation of the vitiligo patch.The basic principle is transfer of normal colour producing melanocytes from patients normal skin to the area that has turned white due to absence of melanocytes.
There are various types of grafting done for vitiligo like mini punch graft, suction blister graft, ultrathin split thickness grafts, epidermal cell suspension method. The common type of grafting is the mini-punch graft. This is the easiest, fastest and cheapest of all .In this technique, small bits of normal skin measuring 1-2mm are harvested from the donor area of the patient.
On vitiligo involving special areas like lip and eyelid, suction blister graft is done. Here the graft obtained is ultrathin matching with the above said areas where the skin is very thin. The ultrathin split thickness grafts in vitiligo is considered as the most successful among all.Although the procedure requires a fair amount of surgical expertise, it is still a cost effective method of grafting giving excellent cosmetic results. The difference here is it involves transferring of only the upper most part of skin called as epidermis. The thickness of the graft is hardly 0.1 to 0.7mm giving a better cosmetic results to the vitiligo patch. The thinnest grafts give best result and proper surgical skill is important in obtaining a thin graft. The above mentioned grafts come under the tissue grafts.
The limitation in tissue graft is that large amount of donor skin is needed if we have to cover large areas of vitiligo. In these methods there is no cell expansion. This is where the newer methods of cell grafts have gained popularity. One among the cell graft technique is known as epidermal cell suspension method. The greatest advantage is a small size of donor skin can be used to cover large areas of vitiligo.
The time taken for surgery is around 2-3 hours. The post operative complications are negligible. Maintaining the dressing at the recipient site is of utmost importance for the graft to be “taken”. Immediately after surgery the repigmentation will not be seen in most of the methods. The transferred melanocytes take time to start producing pigment in the grafted area. Post surgery, the patient should continue phototherapy either by exposing the area to sunlight or artificial UV light source for earlier and even repigmentation..It might take 3-6 months for a good colour match to appear. Thegraft can be performed in any age group including children.The safety and efficacy of the skin graft is well established for patients with resistant patches of vitiligo which do not respond well to medical managements these various types of skin grafts have been a ray of hope. The above mentioned treatment options like various skin grafting methods and phototherapy is available at JSS Hospital.
(Writer is Asst. Prof, Department of Dermatology, JSS Medical College Hospital, Mysuru).