Surgical therapy of vitiligo: current status.

Vitiligo is an acquired condition that presents as sharply demarcated white macules. It affects 1%-2% people of all races regardless of sex and age. Although the disease does not have any systemic complications, it is of great cosmetic concern, particularly in darker skinned individuals, as in Indians, where it creates psychological problems due to the stigma attached to it. In vitiligo, there is a partial or total destruction of melanocytes, initially only of the epidermis, and later even of the hair follicle, which acts as a reservoir for providing melanocytes during repigmentation. Hence, in patients with vitiligo, the existing melanocytes need to be activated. While medical therapies are the primary treatment, there are some patients refractory to medical treatment. In such patients, surgical therapies can be used either alone or in conjunction with medical therapy to achieve repigmentation provided the disease is stable. Stability has been defined by different authors as a period varying from 6 months to 2 years during which the existing lesions should not have enlarged, no new lesions should have developed, and there should be no koebnerization. It is best to confirm the stability of the disease by doing trial test grafting in a small vitiliginous area 11⁄2-2 months before undertaking surgery of the entire lesion.