Vitiligo, a chronic skin condition that causes areas of the skin to become depigmented, could be treated more successfully with new surgical methods, claims a US dermatologist.
Vitiligo most often affects the face, elbows, knees, hands and feet, and the condition is more noticeable in people with darker skin tones.
The most common treatments for vitiligo include topical medications and light therapy that can be used in combination to restore pigment.
One of the new surgical techniques includes skin grafting, where normal skin is used as donor tissue and then grafts are surgically transplanted on areas of vitiligo. The new skin grafts start producing pigment.
Patients who are candidates for this procedure must have stable vitiligo, or vitiligo that has not changed for at least six months.
This procedure can be used for patients with limited areas of vitiligo and also in those with more extensive disease. Patients can decide to use grafts on one area of the body (such as the face) and choose another therapy for other areas affected by vitiligo (such as the hands).
Skin grafting has a high success rate - 80 to 90 percent in most patients.
This in-office procedure is not widely used in the United States but is commonly used in other countries (particularly in South America, Europe, Southeast Asia, India and China).
In melanocyte transplants, melanocytes and keratinocytes (the cells of the top layer of skin) are obtained surgically under local anesthesia from the patient and then grown in a culture in the lab overnight.
This therapy is administered in-office and best used in areas of limited vitiligo where the vitiligo has been stable for at least six months.
Melanocyte transplants have a very high success rate of 95 percent.
Maintenance following surgery is another latest technique, where phototherapy often is used after both skin grafting and melanocyte transplants to stimulate cells to make new pigment faster in treated areas.
As far as topical therapies are concerned, results vary from patient to patient and Dr. Halder noted that on average 45 to 50 percent of patients have an acceptable response using topical therapies to restore pigmentation.
The duration of treatment is approximately four to six months, but patients may need maintenance therapy if pigmentation is lost following the course of treatment.
In cases where less than 20 percent of the skin surface is affected by vitiligo, different strengths of topical corticosteroids can be applied to nearly any part of the skin where vitiligo is present, including the face.
However, a weaker concentration may be prescribed for the face, as some concentrations may be too strong.
One of the main side effects of long-term topical corticosteroid use is thinning of the skin. For this reason, this therapy must be monitored carefully in children.
Topical immunomodulators, or calcineurin inhibitors, can regulate the local immune response of the skin. Two therapies used to treat vitiligo are tacrolimus and pimecrolimus.
There are several types of laser and light therapies that can help treat vitiligo, and a few require the patient to be exposed to a controlled dose of ultraviolet (UV) light.
For very extensive vitiligo in which more than 50 percent of the skin surface is affected or if the condition results in facial disfiguration, some patients opt for depigmentation (a form of bleaching the skin) to blend the remaining pigmented skin with areas of vitiligo.
"It is important for anyone who notices any unusual changes in the pigmentation of their skin to see a dermatologist, as vitiligo treatments are more successful the earlier they are started," said Dr. Halder.
"The newest surgical grafting techniques and transplant procedures hold a lot of promise for successfully treating vitiligo, and I think we'll see more dermatologists offering these cutting-edge procedures in this country in the future," Dr. Halder added.