It must be first and foremost noted that surgical treatment is not recommended for all vitiligo patients and that the failure of every other therapy and, most of all, the ascertained stability of the disease are the essential prerequisites.
In this respect, the following assessment criteria are considered valid: absence of new patches in the two years prior to dermatologic check-up; absence of enlargement of the already existing patches during the same period of time; possible spontaneous re-pigmentation internal or peripheral to the vitiligo patches; one-sided vitiligo; mini-transplant test, i.e. a simple proceeding for the accurate assessment of the expected positive or negative surgical response.
Can cause side effects and complications: scars, usually minimal, not rare in donor areas when in-vitro melanocytes culture techniques are used.
Cobblestoning, i.e. a phenomenon consisting in the appearance of variously sized protrusions, once the healing has occurred.
Hyper-pigmentation or hypo-pigmentation of the transplanted areas, phenomena that vary according to the subject, generally of minor entity but common to all the methods used.
Infections: very rare but still possible.
Especially in case of widespread patches, surgical treatment can result ineffective. It is contraindicated in children and not recommended on emotionally unstable patients.
Autologous skin transplant
Consists in transplanting some skin sections taken from normally-pigmented areas of the patient into the vitiligo patches. Transplant is usually performed 2-3 days after preparing thereceiving area using various surgical techniques (preparation of very thin skin strips, formation of blisters by means of cryoprobes or suction, full thickness punch, minipunch).
Re-pigmentation occurs gradually, starting from the edge of the transplanted skin fragment. A few PUVA therapy cycles may accelerate the re-pigmentation and uniform the color of the transplanted skin areas. This method (only possible for small patches) can cause vitiligo on the donor areas, beyond other relevant phenomena, and is therefore not recommended.
Autologous transplant of in-vitro cultured skin
Once taken a very thin sample of skin from a normally-pigmented area of the patient, the melanocytes (obtained separating epidermis from dermis) are being cultured in-vitro for approximately 1 month. When an adequate number of melanocytes is reached, the same are transplanted by injection into the suction blisters produced within the vitiligo patches.
Another method lies in growing melanocytes together with keratinocytes on a collagen-coated membrane and, after 2 weeks, transplanting this membrane into the achromic receiving areas. Even though they are relatively experimental techniques, their value has already been demonstrated on widespread vitiligo patches.
Regardless of the various taking and transplanting techniques, the in-vitro culture of melanocytes provides excellent potential benefits for the treatment of vitiligo. However, the remote possibility of an undesired transformation of the in-vitro cultured melanocytes requires a better knowledge of biological cell reproduction, in order to safely avoid any risk.
Autologous transplant of non-cultured melanocytes
It is a technique that requires the taking of two square centimeters of skin from the occipital region of the patient. 24 hours later the epidermis is separated from the dermis and soaked into a special solution.
After separating the basal membrane from the epidermal cells (keratinocytes and melanocytes) the suspended cells are injected into the blisters produced in the receiving areas.
This technique is currently under study, but researchers found it to be more efficient and simpler than the others.
Some studies on the possibility of using stem cells are being currently conducted as stem cells can differentiate into melanocytes.