Surgical Techniques for Vitiligo: A Review
N. van Geel, K. Ongenae, J.-M. Naeyaert
Although the treatment of vitiligo has improved during the last decade, therapy is still not satisfying for many patients. This is probably due to the fact that the aetiopathogenesis is unknown. Several vitiligo treatment modalities, such as PUVA, UVB and local corticosteroids are currently used in the treatment of active vitiligo. However, these treatments usually induce incomplete repigmentation. Surgical vitiligo methods intended to repigment leucoderma are an interesting therapeutic option if patients have stable disease. Two types of surgical techniques are available: tissue grafts and cellular grafts, with in between autologous cultured epithelial grafts. Tissue grafts are full-thickness punch grafts, split-thickness grafts and suction blister grafts. With tissue grafts, only a limited surface area can be treated but with good results in the majority of cases. Cellular grafts include non-cultured keratinocytes/melanocytes and cultured melanocytes. The exact success rate of repigmentation with cellular grafts is still unknown, since only a small number of studies have been published. Starting from autologous cellular suspensions, epithelial grafts of various compositions can be cultured in vitro. They can be used for larger areas. The purpose of this review is to describe the applications of different vitiligo surgical techniques used to treat recalcitrant vitiligo.
Copyright © 2001 S. Karger AG, Basel
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Author Contacts
J.-M. Naeyaert, MD, PhD
Department of Dermatology
Ghent University Hospital
De Pintelaan 185, B-9000 Ghent (Belgium)
Tel. +32 9 2402298, Fax +32 9 2404996, E-Mail jeanmarie.naeyaert@rug.ac.be
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SURGICAL TECHNIQUES FOR VITILIGO : A Review
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What is Vitiligo?
Vitiligo is another term employed for Lucoderma. It is an auto immune chronicle skin disorder believed to be genetical in nature.
How is it caused?
Merely 2% of the total global population suffers from Vitiligo, which may be caused by varied factors, these can be both genetic and non genetic in nature. The basic cause behind the Vitiligo disease is the destruction of melanocytes of Vitiligo patients; at a particular region which is subjected to hypo pigmentation or no pigmentation at all.
There is however different theories put forth for this disease some of them are,
1) Auto immune theory: - The autoimmune theory proposes an alteration in humoral and cellular immunity in the destruction of melanocytes of Vitiligo
2) Stress:- this is another cause for the disease patients undergoing acute stress related disorders are prone to Vitiligo disease.
3) Neuron theory:- Vitiligo is also believed to be caused by external or internal injuries, where neuronal connection is destroyed at the tissue level and failure to collaborate with the brain may cause the annihilation of melanocytes at this particular faction of the body.
4) Hormonal Theory:- Hormonal theory is generated on the disorder caused by disturbances in hormones in the body hence Adisons disease, diabetes melitis and other such categorized diseases are said to enhance the chances of Vitiligo . Thyroid disturbances are also seen as a potent factor in the contemplation of Vitiligo.
What are the symptoms and on set age of Vitiligo ?
The onset for Vitiligo disease is around the age of 20 and may vary in sex age and race being more prominent in the individuals hailing from Africa and Asian landmass who have dark and brown skins. Initiating with a small patch of depigmented skin, part generally at the extremities of the body such as hands and legs the depigmented part continues to engulf the body gradually with time however there are side effects of this disease one of which is that the individual becomes much sensitive to sunlight.
Treatment of Vitiligo?
Treatment may vary form homeopathy to allopathy. Homeopathy believes firmly that Vitiligo is a form of disease or the warning expression of the body to give out clear signals for internal disturbance of the body. Many homoeopathic medicines such as Arsenic Sulph Falvus, Arsenic Album, Baryta Mur and Baryta Carb are potent antidotes for Vitiligo; on the allopathic front corticosteroid cream is considered as the best available antidote in the market.
Social stigma attached with Vitiligo?
One of the most common problem with Vitiligo is the social stigma attached with it in many developing countries like India, Vitiligo is considered as wrath of gods upon an individual, not only this, but a social stigma of untouchables is attached with the disease. The height of ignorance is such that people mistake it as a communicable disease and the person suffering with Vitiligo disease not only suffer externally on the epidermis but also internal psychological traumas give rise to much bewildering hours and sleepless nights. The social stigma may even go to the extent that marriages with such homes with Vitiligo is neither initiated nor cherished.
Though Vitiligo is not a viral disease and anyone can acquire it, the patients suffering from Vitiligo needs some extra care and sympathy rather than apathy on the home and social level.
Vitiligo - Lee Thomas - Turning White 2020 Interview
How Is Vitiligo Diagnosed?
To help affirm the diagnosing of vitiligo, the Dr. could ask a little sampling of the involved skin to analyse below a microscope. In vitiligo, the skin sample distribution will generally display a complete absence of pigment-producing melanocytes. Then again, the presence of inflamed cells in the sample might propose that a different condition is causative of the deprivation of pigmentation.
As vitiligo may be connected with malignant anaemia (a precondition in which an inadequate amount of vitamin B12 is ingested from the digestive tract) or hyperthyroidism (a hyperactive thyroidal gland), the Dr. could in addition take a blood sample to assay the blood cell number and thyroid function. For some patients, the Dr. could urge an optic (eye) exam to assure for uveitis (inflammation of part of the eye), which sometimes occurs with vitiligo. A blood test to look for the presence of antinuclear antibodies (a type of autoantibody) could also be made out. These essays aids in determining if the patient has additional autoimmune disorders.
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TEN IMPORTANT QUESTION ABOUT VITILIGO
What do you think is causing my problem?
Is there more than one condition (disease) that could be causing my problem?
What tests will you do to diagnose the problem and which of the conditions is present?
How good are the tests for diagnosing the problem and the conditions? How safe are the tests?
What is the likely course of this condition?
What is the long-term outlook with and without treatment?
What are my treatment options?
How effective is each treatment option?
What are the benefits versus risks of each treatment option?
If my symptoms worsen, what should I do on my own?
When should I contact you?
Are you aware of each of the medications that I am taking?
Can they adversely interact with the medications you are prescribing for me?
Should we monitor for side effects of the medications that you are prescribing or for their interactions with other medications I am taking?
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