Surgical Therapies
All surgical therapies must be
considered only after proper medical therapy is
provided. Surgical techniques are time-consuming and
expensive and usually not paid for by insurance
carriers. They are appropriate only for carefully
selected patients who have vitiligo that has been stable
for at least 3 years:
- Autologous skin grafts—the
doctor removes skin from one area of your body and
attaches it to another area. This type of skin
grafting is sometimes used for patients with small
patches of vitiligo. The doctor removes sections of
the normal, pigmented skin (donor sites) and places
them on the depigmented areas (recipient sites).
There are several possible complications of
autologous skin grafting. Infections may occur at
the donor or recipient sites. The recipient and
donor sites may develop scarring, a cobblestone
appearance, or a spotty pigmentation, or may fail to
repigment at all. Treatment with grafting takes time
and is costly, and many people find it neither
acceptable nor affordable.
- Skin grafts using blisters—in
this procedure, the doctor creates blisters on your
pigmented skin by using heat, suction, or freezing
cold. The tops of the blisters are then cut out and
transplanted to a depigmented skin area. The risks
of blister grafting include scarring and lack of
repigmentation. However, there is less risk of
scarring with this procedure than with other types
of grafting.
- Micropigmentation (tattooing)—this
procedure involves implanting pigment into the skin
with a special surgical instrument. This procedure
works best for the lip area, particularly in people
with dark skin. However, it is difficult for the
doctor to match perfectly the color of the skin of
the surrounding area.
The tattooed area will not
change in color when exposed to sun, while the
surrounding normal skin will. So even if the
tattooed area matches the surrounding skin perfectly
at first, it may not later on. Tattooing tends to
fade over time. In addition, tattooing of the lips
may lead to episodes of blister outbreaks caused by
the herpes simplex virus.
- Autologous melanocyte transplants—in
this procedure, the doctor takes a sample of your
normal pigmented skin and places it in a laboratory
dish containing a special cell-culture solution to
grow melanocytes. When the melanocytes in the
culture solution have multiplied, the doctor
transplants them to your depigmented skin patches.
This procedure is currently experimental and is
impractical for the routine care of people with
vitiligo. It is also very expensive, and its side
effects are not known.
Additional Therapies
In addition to medical and surgical
therapies, there are many things you can do on your own
to protect your skin, minimize the appearance of white
patches, and cope with the emotional aspects of
vitiligo:
- Sunscreens—people who have
vitiligo, particularly those with fair skin, should
minimize sun exposure and use a sunscreen that
provides protection from both the UVA and UVB forms
of ultraviolet light. Sunscreen helps protect the
skin from sunburn and long-term damage. Sunscreen
also minimizes tanning, which makes the contrast
between normal and depigmented skin less noticeable.
- Cosmetics—some patients with
vitiligo cover depigmented patches with stains,
makeup, or self-tanning lotions. These cosmetic
products can be particularly effective for people
whose vitiligo is limited to exposed areas of the
body. Dermablend, Lydia O’Leary, Clinique, Fashion
Flair, Vitadye, and Chromelin offer makeup or dyes
that you may find helpful for covering up
depigmented patches. Selftanning lotions have an
advantage over makeup in that the color will last
for several days and will not come off with washing.