When to use them

It should first and foremost be noted that surgical treatment is not appropriate for all vitiligo patients, and that failure of all other attempted treatments and, especially, the ascertained stability of the disease represent the necessary prerequisites. In this respect, the following assessment criteria are adopted: no onset of new patches during the two years prior to dermatological examination; no spreading of the existing patches during the same time period; possible naturally restored pigmentation within or on the edge of the vitiligo patches; one-sided vitiligo; minitransplant test, a simple practice for the accurate assessment of the expected positive or negative response to surgical treatment.

Surgical repigmentation may result into side effects and complications: scarring, mostly negligible, not infrequent in donor regions if in vitro melanocyte culture techniques are used.

Cobblestoning, i.e. onset, after healing, of protrusions of variable sizes.

Hyperpigmentation or hypopigmentation of the transplanted areas, at varying degrees in different patients, usually moderate but common to virtually all methods used.

Infections: infrequent but still possible.

Surgical treatment may easily fail in case of widespread patches; it is contraindicated in children and not recommended in emotionally impaired patients.

Autologous skin transplant

This treatment provides for the transplant of skin sections, taken from normally pigmented areas of the patient's skin, into the vitiligo patches. transplant is usually performed 2-3 days after preparing the receiving area by means of various surgical techniques (shaving off of very thin strips, production of blisters by means of cryoprobes or suction, full-thickness punch, minipunch). Repigmentation occurs progressively starting from the edge of the transplanted skin fragment. A few PUVA-therapy cycles could speed up repigmentation and help make the colour of the transplanted skin more even. Such method (to be limited to small patches) may result into the onset of vitiligo in donor areas, as well as in other significant negative effects, and is therefore not recommended.

Autologous transplant of in-vitro cultured skin

A very thin skin layer is taken from a normally pigmented area of the patient’s skin. The melanocytes obtained after separating the epidermis from the dermis are cultured in vitro for approximately one month. Upon reaching the appropriate quantity of melanocytes, transplant of the same is performed by injection into the suction blisters produced within the vitiligo patch. Another method provides for growing melanocytes together with keratinocytes on a membrane coated with collagen and transplanting such membrane into the receiving achromic regions after 2 weeks. While these techniques are still at an experimental stage, their value has already been demonstrated for very large vitiligo patches.

Apart from the different taking and transplanting techniques, the in-vitro culture of melanocytes for the surgical treatment of vitiligo provides excellent potential benefits. On the other hand the possible, though remote, undesired transformations of the in-vitro cultured melanocytes call for in-depth knowledge of biological cell reproduction, in order to safely exclude any risks.

Autologous transplant of non-cultured melanocytes

This technique provides for taking of two square centimetres of skin from the patient’s occipital region. After 24 hours the dermis is separated from the epidermis and the latter is soaked into a special solution. The epidermal cells (keratinocytes and melanocytes) are separated from the basal membrane, then the suspended cells are injected into the blisters produced in the receiving regions. This technique is deemed more effective and easier than the above described methods, and is currently also under study.