Vitiligo Surgeries

Natural color of the skin is because of Melanin, a pigment produced by certain cells called Melanocytes in the upper layers of skin. Melanin protects the skin from harmful UV Rays.

Destruction of these melanocyte manifest as white patches.

This affects approximately two to three percent of the Indian population.

A white spot of vitiligo on the skin, although only cosmetic in nature, has a devastating effect on the psychology of that individual as it distorts the body image, causes anxiety and depression .

Although it is not contagious this disease has tremendous social stigma. it is difficult to find a mate for marriage. Not only for the person affected with vitiligo, but also for the unaffected sibling.

Types of vitiligo

Vitiligo Vulgaris : The most common presentation in which the patches are distributed bi- laterally symmetrical.

Acrofacial Vitiligo : Patches are on fingers, toes, palms, soles and around facial orifices.

Segmental Vitilgo : Occurs in a unilateral asymmetric distribution spreading over one or more dermatomes.

Lip-tip Vitilgo : Patches are restricted only to lips and distal parts of the fingers and toes.

Focal Vitilgo : One or two closely set depigmented patches localised to a single area.

Universal Vitilgo : Loss of pigment over the entire body surface except a few small islands of pigmented skin.

 Treatment

Medical :

1. Medicines like psoralines combined with sunlight exposure,

2. Topical /oral steroids

3. Topical Tacrolimus, Pimecrolimus, Calcipotriol etc.

4. Ultra violate Light therapies, Lasers etc

These modalities are aimed to stimulate the viable melanocytes in the spots of vitiligo.to produce color. There is good repigmentation with these provided there are viable melanocytes in the patch of vitiligo. Hair roots in the skin have plenty of melanocytes which are stimulated with treatment to produce the color which migrates to the surrounding skin.

But If the melanocytes in the spots are destroyed then response to these treatments is poor. In such situation certain surgical treatments are preferred for speedy repigmentation of the spots.

Surgical :

Melanocyte Transplant surgery : Melanocyte transplantation is the most advanced surgical method to treat vitiligo / leucoderma.

What is that ?

A small piece of healthy skin of the patient is taken out , the pigment cells from this piece are extracted & spread on the patch of vitiligo to be treated.

When it is done?

When the patches do not respond , or respond very slowly to medicines and phototherapy.

Vitiligo patients should fulfill the following criteria to be eligible for surgery:

1. Patches should not have increased in size. for at least last 6 mths.

2. No new patches should have appeared on other areas of the body.

3. Any injury should heal with normal skin color.

The Operation Steps :

1. A thin skin piece{ donor skin) is taken under local anaesthesia. This is normally taken at the top of the thigh.

2. This donor skin is processed using an enzyme(trypsin) to separate the cells of skin and to make a skin cell suspension. 
   This suspension is rich in melanocytes – the cells which produce the skin colour .

3. The area to be treated (white spot) is gently abraded, under local anaesthetic, and the skin cell mixture is applied over this abraded skin. Proper dressing is done which is removed after about 8 days.

The skin cells attach themselves and the healing and repigmentation process begins

Post Operative :

Treated areas remain pink after removal of dressing.

1. Earliest pigmentation is seen within 3-6 weeks

2. Entire area covers up in 3 to 4 months.

3. Excellent cosmetic results are seen in 5-6 months.

FAQs!

1. Is the pigmentation on the patch permanent ? 
   Yes, in the absence of activation of the disease,96% of patients treated have not lost the pigmentation

2. Can lips and finger tips be treated? 
   Yes, though the overall success rate is 78%, in case of lips & finger tips we may require more than one sitting to obtain 100% pigmentation.

3. Cost - Factor ? 
   Melanocyte transplantation though an advanced procedure is also a cost-effective treatment comparable to other modalities of treatment for vitiligo.

4. What are the limitations of the procedure ? 
   We cannot treat patients who have more than 30% body surface affected by vitiligo.

5. Is it a plastic surgery ? 
   It is not a plastic surgery, or cosmetic surgery, as the procedure involves transplantation of Melanocytes, which is not done by plastic surgeons and this procedure is now considered as a treatment modality for vitiligo and thus it also cannot be considered as cosmetic surgery.

6. Is any dietary restrictions necessary during the course of treatment for Vitiligo ? 
   No at present, no one has conclusively shown any dietary factors to be responsible for causing Vitiligo.

7. What is difference between Melanocyte Transplantation and Melanocyte culture? 
   Melanocyte transplantation involves separating melanocyte from small piece of skin and transplanting it immediately onto the patches, though a smaller area can be treated it is absolutely safe, but in melanocyte culture, the cells are separated from a small piece of skin, and it is cultured in the laboratory (increase in the no of cells) is achieved by using cultured media and growth factors