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Surgical Management of Vitiligo

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Surgical Management of Vitiligo

4 min read


Surgery for vitiligo is a good option for a patient who is not responding to medical treatment. But, patients are not aware of this option. This article discusses the surgical management of vitiligo.

Written by

Dr. Suvash Sahu

Medically reviewed by

iCliniq medical review team

Published At July 28, 2016
Reviewed AtJuly 27, 2023

What Is Vitiligo?

Vitiligo, also known as white patch disease, is characterized by amelanotic or hypomelanotic patches anywhere over the body. To date, there is no definite etiology known for vitiligo. This skin disease has great social consequences in our modern society in spite of it being non-contagious in nature.

What Are the Causes and Pathogenesis of Vitiligo?

  • A positive family history of vitiligo is relatively common in those with extensive diseases.

  • It can also be associated with other autoimmune diseases.

  • Trauma and sunburn may (through the Kobner phenomenon) precipitate the appearance of vitiligo.

  • The pathogenesis is unclear, and melanocytes may be the target of a cell-mediated autoimmune attack, but it is unknown why only focal areas are affected.

What are the Stages of Vitiligo?

Vitiligo can be divided into three stages:

  1. Active or progressive stage.

  2. Stable or quiescent stage.

  3. Repigmenting stage.

  • The active or progressive disease stage is when the depigmented lesions or white patches are increasing in size or number and borders are not well defined.

  • A stable or quiescent disease stage is when there are no new lesions or patches or changes in existing lesions and borders are well defined.

  • The Repigmenting disease stage is where there is marginal pigmentation around hair follicles.

What Are the Types of Vitiligo?

There are five different types of vitiligo, and it depends on where you have it.

1) Generalized:

  • It is the most common type.

  • The discolored patches are seen all over the body.

2) Segmental:

  • The discolored patches are seen on one area of the body, for example, face, hands, etc.

3) Non-segmental:

  • It is the most common type.

  • Symmetrical white patches are seen with slower development.

4) Focal:

  • It mostly occurs in young children.

  • It stays in one spot and does not spread.

5) Trichrome:

  • It is a combination of three discolorations with heavy discoloration in an area, followed by an area of lighter discoloration and regular skin color.

6) Universal:

  • It is very rare.

  • Almost 80% of the skin is discolored.

Who Is More Likely to Get Vitiligo?

  1. Vitiligo is an acquired condition affecting 1% of the population worldwide, and it is the focal loss of melanocytes resulting in the development of patches with hypopigmentation.

  2. It occurs equally in men and women.

  3. It occurs at the early stages of life, that is, between 10 to 30 years of age, and it mostly shows before 40 years of age.

  4. It occurs with a family history of vitiligo and in people with or family history of premature grey hairs.

How Is Vitiligo Clinically Identified?

1. Generalized Vitiligo - It is often symmetrical and involves hands, wrists, knees, and neck, as well as areas around body orifices. The hair of the scalp, beard, eyebrows, and lashes may also depigment.

2. Segmental Vitiligo - It is restricted to one part of the body but not necessarily a dermatome (skin supplied by a single spinal nerve). The depigmentation patches are sharply defined, and in Caucasians may be surrounded by hyperpigmentation.

Within the depigmentation, the spotted perifollicular pigment may be seen and is often the first sign of repigmentation; also, sensations in the depigmented patches are normal.

Wood’s light examination enhances the contrast between pigmented and non-pigmented skin. The course is unpredictable, but most patches remain unchanged or enlarged, and a few patches start to repigment spontaneously.

3. Non-segmental Vitiligo - It most commonly occurs on the face, neck, hands, and the areas which are commonly exposed to the sun. It is subdivided into generalized (no specific area), mucosal (lips and mucous membrane), acrofacial (fingers and toes), universal (seen in most areas of the body), and focal (one particular area).

Common areas include:

  • Backs of the hands.

  • Arms.

  • Eyes.

  • Knees.

  • Elbows.

  • Feet.

  • Mouth.

  • Armpit and groin.

  • Nose.

  • Navel.

  • Genitals and rectal area.

What is the Surgical Treatment for Vitiligo?

General Management of Vitiligo:

  1. Various modalities have been used to treat vitiligo, which includes phototherapy, photochemotherapy, topical and systemic steroids, immunomodulating agents like Levamisole, calcineurin inhibitors like Tacrolimus, etc.

  2. Protecting the patches from excessive sun exposure with clothing or sunscreen may be helpful to avoid sunburn.

  3. Camouflage cosmetics may be beneficial, particularly in those with dark skin, and also topical corticosteroids are highly effective.

  4. Phototherapy with narrowband UVB or PUVA can be used. Narrowband UVB is the most effective repigmentary treatment available for generalized vitiligo, but even very prolonged courses often do not produce a satisfactory outcome.

  5. The absence of leucotrichia (white hairs in the area of vitiligo) and a trichrome pattern (three colors – normal skin color, hypopigmentation, and depigmentation) are good prognostic features.

  6. Vitiligo on the face, trunk, and proximal limbs are more likely to respond than that on hands and feet. Autologous melanocyte transfer, using a range of techniques, including split-skin grafts and blister roof grafts, is sometimes used on dermabraded (skin used in dermabrasion technique) recipient skin.

  7. The impact of vitiligo differs markedly between populations. For example, in the Indian subcontinent, the effects are more readily visible than in pale-skinned individuals in northern Europe.

  8. Depigmentation is also seen in Hansen’s disease (leprosy), which means that individuals with vitiligo are often marked out.

Surgical Management of Vitiligo:

Many patients get complete repigmentation with medical treatment, but a vast number of patients do not respond satisfactorily to medical treatment. Hence, the need for surgical treatment is required.

Surgical treatment for vitiligo is indicated when the disease is stable and resistant to conventional medical therapy. The advantage of surgical treatment is that it provides long-lasting pigmentary cover over a short period of time.

There are various surgical modalities, such as-

  1. Punch grafting.

  2. Thin split-thickness skin grafting.

  3. Suction blister grafting.

  4. Tattooing.

  5. Dermabrasion.

  6. Cultured skin grafting.

  7. Others, including trypsinized autologous grafting, excision, etc.

Surgical treatment for vitiligo is indicated for patches resistant and stable for at least one year of time. If a small area or small patches are depigmented, it can be treated with punch grafting and suction blister grafting. If a large area or large patches are involved, thin split-thickness skin grafting, dermabrasion, and culture techniques like melanocytes transplantation are useful.

What Are the Complications of Vitiligo?

  1. Sunburn.

  2. Eye problems.

  3. Ear problems.

  4. Excessive tear production.

  5. Psychological stress.

  6. Anxiety.

  7. Depression.

  8. Problems with self-esteem.

  9. Vitiligo is likely to develop other autoimmune disorders, but it is not seen in all vitiligo patients, but some of them may tend to develop any of the following. They are:

  10. Thyroid problems.

  11. Addison’s disease.

  12. Hashimoto’s thyroiditis.

  13. Type 1 diabetes.

  14. Pernicious anemia.

To know more about the treatment options of vitiligo, consult a vitiligo specialist online.

Frequently Asked Questions


What Are the Various Triggers of Vitiligo?

In vitiligo, the primary cause is the immune system destroying the melanocytes in the skin. So any trigger to the immune system has a high probability of causing vitiligo. Other triggers are sunburn and altered emotional distress.


Can I Get Rid of Vitiligo?

Unfortunately, there is no definitive cure for vitiligo. Treatments can only help in reducing the course of the disease. Various methods cover up the skin’s hypopigmented areas to give an esthetic appearance in the affected individual.


Is Vitiligo Hereditary?

Yes, vitiligo is noted to be hereditary. In various studies, it is said to be because of the interaction between genes and unknown underlying environmental factors or triggering factors.


How Quickly Can Vitiligo Spread in My Body?

In certain people, the hypopigmented patches do not spread. But in the majority of people, the white patches usually spread to other areas of the body. Likewise, in a certain group of individuals, vitiligo spreads slowly, where it takes many years. For some, it also spreads quickly. It is really hard to predict the spread of vitiligo.


Can Emotional Stress Trigger Vitiligo?

Yes, both emotional stress and physical stress can trigger vitiligo. It is a complex skin disease that involves a combination of faulty genes and varied environmental factors.


Can Vitiligo Go Away by Itself If Left Untreated?

Vitiligo reduces by itself very rarely. Sometimes, in certain people, little or all of the lost pigment eventually returns on its own, and the white patches completely disappear. However, in the majority of people, the hypopigmented skin patches last and grow larger if vitiligo is not treated adequately.


Is Vitiligo a Sexually Transmitted Disease?

It is a common myth about vitiligo that it is a sexually transmitted disease. The fact is that it is not a contagious condition, and it cannot spread from activities like touching. It can also not spread through saliva, inhalation, blood, sexual intercourse, or sharing of personal items.


At What Age Does Vitiligo Start?

Vitiligo can start at any age, but vitiligo first appears between 20 and 30. The hypopigmented patches may initially begin on the affected individual’s face above his or her eyes. It can also occur in the neck, armpits, elbows, genitalia, hands, or knees. These hypopigmented patches often develop symmetrically, and it can spread over the affected person’s entire body.


Does Vitiligo Show Immediate Symptoms?

Yes, vitiligo shows immediate symptoms. The following are the most common signs of vitiligo:
- A patchy loss of skin color, which initially starts to appear on the hands, face, and areas around body openings like the nose, ear, and the genitals
- Premature graying of the hair on the affected individual's scalp, eyelashes, eyebrows, and even their beard.
- Loss of pigment in the tissues that histologically line the inner surface of the mouth and nose.


Does Vitiligo Aggravate With Age?

Vitiligo is a complicated condition which has only a very few scientific evidence. This condition can initiate at any age and can become more severe over time. There are no studies to show that vitiligo is associated with aging.


What Are the Other Conditions Similar To Vitiligo?

The following are the various skin conditions that are often misdiagnosed as vitiligo.
- Idiopathic guttate hypomelanosis.
- Nevus depigmentosus.
- Albinism.
- Piebaldism.
- Melasma.
- Tinea versicolor.
- Progressive macular hypomelanosis.
- Pityriasis alba.


What Foods Should Be Avoided in Vitiligo?

Avoiding the following foods can prevent vitiligo from becoming severe.
- Alcohol consumption.
- Blueberries.
- Citrus fruits.
- Caffeinated drinks.
- Curd and associated dairy products.
- Fish.
- Fruit juices.
- Gooseberries.


What Are the Symptoms of Mild Vitiligo?

In a person with mild vitiligo, the hypopigmented patches are noted to be small, and they usually appear as segmental or focal patterns. Those small hypopigmented patches are also noted to appear in one or a very few areas only.


Can I Get Rid of Vitiligo Naturally?

Yes, certain natural remedies can reduce the symptoms of vitiligo. Turmeric is one of the effective home remedies for vitiligo. Turmeric should be used along with mustard oil. It results in the stimulation of the skin’s pigmentation. It is advised to be applied for 20 minutes on the affected area. This method should be repeated twice a day for positive results.


How Do I Recognize the Symptoms of Vitiligo?

If you suspect to have vitiligo, you might experience one or more than one of the following symptoms:
- Patchy loss of skin color.
- This hypopigmentation will initially appear on your hands, face, and areas around body openings.
- Premature whitening or graying your hair.


How Can I Stop Vitiligo From Spreading?

Topical steroids can be applied as cream or ointment on your skin. This method can stop the spread of the hypopigmented patches. It can also help in restoring some of your original skin colors. However, you are not supposed to use this without a doctor’s prescription, as these drugs consist of potential side effects.


Is Vitiligo a Contagious Disease?

No, vitiligo is not a contagious disease. It can affect individuals who only have a defective gene and environmental triggers. It can never spread from body secretions.


What Foods Help in Relieving Vitiligo?

Intake of the following foods can help in relieving vitiligo.
- Bananas.
- Apples.
- Leafy greens and vegetables.
- Garbanzo beans.
- Root vegetables, such as beets, carrots, and radishes.
- Dates.
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Dr. Suvash Sahu
Dr. Suvash Sahu



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