Vitiligo or white patches are also more commonly known as leucoderma. The real cause of this particular condition is still unknown by and large. Whatever limited evidence we have points out to a possible immune disregulation that interferes with melanogenesis.
It is not a physical disease but a social one. There are most often than not, no other symptoms except the appearance of light coloured patches in the skin. It may be localized or a more generalized condition and at times most of the body may be involved over a period of time.
The primary Vitiligo treatment is best done by a dermatologist and an effort to limit the spread of the white patches. The onset of action may vary from childhood to adulthood and family history (heredity) is an important factor for the appearance of the condition.
The treatment poses several challenges but control is achieved with adherence and close follows up with the dermatologist.
However, once the patches appear in the visible areas of the body it starts to worry the individual and family members. There is an increased risk of diseases related to sun exposure and appearance of skin malignancies. A good sun protection is mandatory.
Surgical treatment comes to the fore when the individual seeks coverage of the white patches which have been existing. One year stability of the patches is a pre-requisite when we think of treating the area surgically.
Plastic Surgery of white patches or vitiligo involves removing the upper layers of affected skin either by dermabrasion or partially shaving off the skin and applying a very thin layer of skin graft over that area. The donor skin has to be of the same person and it usually takes few days for the donor area to heal. The new skin grafted lends it melanin cells to the white patch area and it gets pigmented. The changes in the grafted skin take place upto 6-12 months following the procedure.
There is no quick fix method for the problem and any surgical intervention has to be planned well in advance (6-12 months) if one is targeting a social event.
Thin split skin grafting is the GOLD STANDARD when we talk about the surgical procedures. There are other methods also like melanocyte transfer and blister grafting both of which again are different forms of grafting melanocyte containing skin to the affected area.
The main challenges of the other modes of surgical treatment is the variability in the pigment spread that occurs and repetition of the procedure is more common than the technique of dermabrasion and thin SSG. Another very successful method to treat small vitiligo patches or areas is excision and primary suturing. In this method the affected area is removed all together with all the layers of the skin and the surrounding pigmented skin is apposed and stitched together. The stitches may be absorbable or non- absorbable which will require removal in the follow up visits.
The anesthesia considerations in the surgical treatment vary with the extent of surgical treatment being done. It could be local anesthesia or general anesthesia. A set of pre operative investigations are advised to see the fitness for the surgery. The donor area heals in about 7-10 days time and slight change in the colour of pigmentation may be noticed.
The treatment of vitiligo patches by surgery does not end with the surgical procedure per se. The grafted area needs to be taken care of for a prolonged period by application of sunscreens, silicone sheets, silicone gel massages and all these post-procedure methods have a significant bearing on the final results.
It must be understood that surgical options are best for limited vitiligo patches or best if we are targeting a few areas. In a more generalized variety with extensive spread of the white patches it is usually not considered a very good option.
A follow up with the surgeon should be maintained for a year and more prolonged follow up with the dermatologist is warranted. There are reports of appearance of fresh vitiligo patches after a surgery but these are really the exception rather than the rule. In general for a limited area a surgical option is considered a very successful therapy.
Vitiligo rules the mind more than the body. The choice to get pigmented skin back on the vitiligo is a personal one. Many times it is driven with the intent of a social goal. One must not weigh the procedural success with the social one. Although we all attempt to do our best to treat but the expectations from the procedure have to be realistic.