Vitiligo Surgical, Laser, and Alternative Therapies: A Review and Case Series

June 2013 | Volume 12 | Issue 6 | Original Article | 685 | Copyright © 2013

Cindy Wassef BA,a Adriana Lombardi MD,b Sairah Khokher MD,c and Babar K. Rao MDc

aUniversity of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ
bDepartment of Dermatology, New York Medical College, New York, NY
cDepartment of Dermatology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Somerset, NJ

Abstract

INTRODUCTION: Vitiligo is a condition caused by the destruction of melanocytes, resulting in areas of skin without pigmentation. While many topical therapies exist for its treatment, not all patients respond to such treatments. Various surgical, laser and other alternative therapies are available for use as well.
OBJECTIVE: The objective of this review was to describe the various surgical, laser, and alternative therapies available for vitiligo. A literature review was conducted through Pubmed and Ovid using the search terms "Vitiligo treatment”, “Vitiligo surgery”, “Vitiligo laser”. Since no articles were available about needling on both Pubmed and Ovid using the search criteria, individual articles were sought out through Google.
RESULTS: The literature review yielded many possible surgical interventions including autologous mini-punch grafting, suction epidermal blister grafting, split-thickness grafting, and cultured and noncultured melanocyte keratinocyte transfer. Laser options included the helium-neon and xenon-chloride lasers, with tattooing and needling serving as other options. While all the above techniques can provide improvement to pigmentation in vitiliginous patches, physician comfort and experience are important factors with regards to outcome. Our case series of four patients treated with the needling method yielded favorable results, with repigmentation rates ranging from 25-50%, with one patient having 90% repigmentation.
CONCLUSION: There are many surgical, laser, and alternative treatment options available for vitiligo when conventional medical therapy fails or for use in conjunction with medical therapies. Autologous mini punch grafting and needling both have minimal equipment requirements and are easy to learn. Physician experience and comfort play a large role in outcome and availability of services.

J Drugs Dermatol. 2013;12(6):685-691.

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INTRODUCTION

Vitiligo is a condition characterized by the autoimmune destruction of melanocytes, resulting in loss of pigmentation. This disease affects 1-2% of the world’s population.1 Many have poor results after treatment with topical and oral medications. Studies show that while 70-80% of patients regain some pigmentation; only 20% regain full pigmentation of affected areas after these treaments.2,3

Medical therapy has been the mainstay of vitiligo treatment. There exists a variety of medical treatments for vitiligo including corticosteroids, tacrolimus, immunomodulators, NBUVB, and PUVA (topical or oral psoralen). Currently, phototherapy is the “gold standard” of vitiligo therapy , but it is time consuming for the patient, with months of weekly visits needed to yield results. While 50% of patients on phototherapy regain some pigmentation, 30% of patients do not respond.4 Other nonsurgical/ laser treatments include phenylalanine, vitamin D-3 analogues, Khellin, 5-flourouracil, pseudocatalase, antioxidant therapy, as well as human placental extracts. Many patients remain refractory to the vast array of non-invasive treatments.4,5

Surgical intervention was first introduced as a treatment option for vitiligo in 1964.1 Since 1964 various surgical techniques for the treatment of vitiligo have emerged including mini-punch grafting, suction blister epidermal grafting, split thickness skin grafting, cultured autologous melanocyte grafting and non-cultured melanocyte-keratinocyte transplantation. Recently, lasers have been introduced into the therapeutic armamentarium for vitiligo, specifically the helium-neon and excimer laser as solotherapy. Another alternative therapy is the newly described needling technique. The purpose of our review is to describe the surgical and laser options available for use in the event of medical therapy failure as well as to present the results of our own experience with needling.

Literatue Review Methods

A search was conducted to gather all relevant data regarding surgical and laser treatments for stable vitiligo using the Ovid and Pubmed databases. Key search phrases included “Vitiligo treatment”, “Vitiligo surgery”, “Vitiligo laser”. In addition, each specific surgical and laser technique was searched. An exception was made for the articles used for the needling section. Since no

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