Chapter 52: Vitiligo

Beginner Tips

• Indicators of a favorable response include stable disease, focal and segmental vitiligo, and facial, neck, and truncal involvement.

• Indicators of an unfavorable response include unstable disease, nonsegmental vitiligo, isolated scalp leukotrichia, and lesions affecting the extremities, distal fingertips, periorificial areas, and joints.

• STSG is the most effective surgical technique for establishing repigmentation in small patches of vitiligo, but it does have limitations.

Expert Tips

• For larger patches of vitiligo, NCES is the most effective treatment option, with the largest number of supporting clinical trials available.

• Adjuvant treatments such as topical immunomodulators, oral corticosteroids, oral antioxidants, phototherapy, and additional surgeries may be necessary after vitiligo surgery to optimize treatment outcomes.

Don’t Forget!

• The size and location of the surgical site, clinical resources, and the risks and benefits of each method should be carefully considered when selecting a surgical technique.

• The Q-switched ruby laser, Q-switched alexandrite laser, and Q-switched Nd:YAG laser are effective modalities for laser-mediated depigmentation in vitiligo.

Pitfalls and Cautions

• Micropigmentation is generally not recommended for camouflage due to associated long-term complications.

• All techniques involve possible risks of undesirable scarring, textural mismatch, and color mismatch.

• These techniques should be used only with extreme caution in patients with a history of keloid formation.

Patient Education Points

• Preoperatively, patients must understand that it may take months to years to achieve the full extent of repigmentation and color match, and that surgery is a treatment, not a cure for the disease.

Billing Pearls

• Although it has been shown to improve quality of life, vitiligo surgery is currently not covered by insurance in the United States, making it unavailable to many patients.