SURGICAL COMBINATION THERAPY FOR VITILIGO AND PIEBALDISM

BACKGROUND. Refractory and stable defects of vitiligo and pie baldism 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 per forming surgical correction of leukoderma. METHODS. Eight patients wit h refractory stable leukoderma were treated with melanocyte transplant ation; three with segmental vitiligo had epidermal shave, by removing the hyperpigmented macules at the periphery of achromic lesions; two o thers received suction epidermal grafts; and three subjects were treat ed by in vitro cultured epidermal autografts. All patients received ad ditional mini-grafts in areas of residual achromia. RESULTS. The depig mented defects were 100% restored in seven patients, and in one subjec t 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.