Vitiligo Surgical, Laser, and Alternative Therapies: A Review and Case Series
June 2013 | Volume 12 | Issue 6 | Original Article | 685 | Copyright © June 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
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 treatmentâ€, â€œVitiligo surgeryâ€, â€œVitiligo laserâ€. 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
Vitiligo is a condition characterized by the autoimmune
destruction of melanocytes, resulting in loss of pigmentation.
This disease affects 1-2% of the worldâ€™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 â€œgold standardâ€ 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 â€œVitiligo
treatmentâ€, â€œVitiligo surgeryâ€, â€œVitiligo laserâ€. In addition, each
specific surgical and laser technique was searched. An exception
was made for the articles used for the needling section. Since no