Surgical Combination Therapy for Vitiligo and Piebaldism

BACKGROUND: Refractory and stable defects of vitiligo and piebaldism may be unresponsive to medical therapy. Melanocyte transplantation can restore the normal pigmentation in some selected patients. OBJECTIVES: To evaluate the efficacy of additional mini-grafting with 1.0-1.2-mm punch grafts to complete the restoration of achromic defects when performing surgical correction of leukoderma. METHODS: Eight patients with refractory stable leukoderma were treated with melanocyte transplantation; three with segmental vitiligo had epidermal shave, by removing the hyperpigmented macules at the periphery of achromic lesions; two others received suction epidermal grafts; and three subjects were treated by in vitro cultured epidermal autografts. All patients received additional mini-grafts in areas of residual achromia. RESULTS: The depigmented defects were 100% restored in seven patients, and in one subject 80% improvement was observed. CONCLUSION: Surgical methods, followed by additional mini-grafting, may be helpful to restore completely the depigmented defects when residual achromia, after treatment with the methods described above, is still present.