Vitiligo Medical and Surgical Management

Practical guidance based on expert experience and evidence for developing management strategies for vitiligo 

This complete guide to vitiligo provides a full appraisal of strategy for the treatment of this autoimmune disease that affects 1-2% of the world’s population. It addresses all aspects of vitiligo, covering the science, medical and surgical therapies, and the psychological evaluations and approaches based on the proper understanding of the causes and classification of a particular case.

Management of vitiligo is challenging and requires a multipronged approach. Vitiligo: Medical and Surgical Management is a comprehensive, timely, state-of-the-art resource that will help those involved with affected patients better understand and treat this disease, which takes its toll on the mental wellness of those afflicted by it. It takes an evidenced-based approach to the disease’s treatment; provides an overview of the surgical management; covers tissue and cellular grafting; and more. 

• Thoroughly guides those involved in the clinical aspects of vitiligo
• Aids diagnosis and classification of severity
• Balances evidence and experience
• Compiled by world-leading expert editors

Comprehensive in nature, Vitiligo: Medical and Surgical Management contains a strong practical element, and is a welcome go-to source for practicing dermatologists and those training to become a dermatologist.

About the Editors

Somesh Gupta, MD, DNB, MNAMS, Professor, Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India

Mats J. Olsson, MD, PhD, CEO, ParkCell AB and President, International Vitiligo Center, Uppsala, Sweden

Davinder Parsad, MD, Professor, Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India

Henry W. Lim, MD, Chair Emeritus, Department of Dermatology and Senior Vice President for Academic Affairs, Henry Ford Health System. Past President, American Academy of Dermatology, Detroit, USA

Nanja van Geel, MD, PhD, Professor, Department of Dermatology, Ghent University Hospital, Ghent, Belgium

Amit G. Pandya, MD, Professor, Department of Dermatology, University of Texas, Southwestern Medical Center, Dallas, USA

List of Contributors xiii

Foreword xix

Preface xxi

About the Companion Website xxiii

Section 1 Basic Science 1

1 Introduction 3
Somesh Gupta and Nanja van Geel

2 Melanocyte and Melanogenesis: Applied Anatomy and Physiology 9
Reinhart Speeckaert and Nanja van Geel

3 Epidemiology of Vitiligo 15
Nader Aboul‐Fettouh and Amit G. Pandya

4 Pathogenesis of Vitiligo 19
John E. Harris

5 Understanding the Mechanisms of Repigmentation in Vitiligo 27
Ravinder Kumar, Davinder Parsad, and Amrinder J. Kanwar

Section 2 Clinical Science 33

6 Classification and Clinical Features of Vitiligo 35
Sang Ho Oh and Seung‐Kyung Hann

7 Outcome Measures for Vitiligo 49
Brian Clinton, Viktoria Eleftheriadou, Nanja van Geel, Laila Benzekri, Amit G. Pandya, and Khaled Ezzedine

8 Evaluation and Treatment of the Psychosocial Burden of Vitiligo 61
Vishal Gupta and M. Ramam

9 Patient Support, Education, and Compliance 69
Richard H. Huggins, Jackie Gardner, and Amit G. Pandya

10 Goals of Vitiligo Treatment, and Evidence‐Based Practice Guidelines for Medical and Surgical Management 77
Kevin Prier and Amit G. Pandya

11 The Concept of Stability of Vitiligo and Stabilization Therapies 81
Anuradha Bishnoi and Davinder Parsad

Section 3 Phototherapy 91

12 Narrow‐Band Ultraviolet B Phototherapy in Vitiligo 93
Narumol Silpa‐archa and Henry W. Lim

13 UVA‐Based Phototherapy: PUVA, PUVA‐Sol, and UVA1 Phototherapy 105
Ljubomir B. Novaković

14 Targeted Phototherapy in Vitiligo 113
Mohammed Al‐Jamal, James L. Griffith, Iltefat H. Hamzavi, and Henry W. Lim

Section 4 Medical Management 123

15 Immunomodulators and Immunosuppressives in Vitiligo Treatment 125
Anuradha Bishnoi and Davinder Parsad

16 Topical Glucocorticoids, Topical Calcineurin Inhibitors, and Topical Vitamin D3 Analogs 133
Sai Yee Chuah and Boon Kee Goh

17 Other Therapies in Vitiligo 141
Narumol Silpa‐archa, James L. Griffith, Iltefat H. Hamzavi, and Pearl E. Grimes

18 Biologic Therapies for Vitiligo 151
Pablo Michel and Amit G. Pandya

19 Evidence Toward Integrated Management of Vitiligo, Combining Ayurveda and Homeopathy with Modern Dermatology 159
Saravu R. Narahari, Madhur G. Aggithaya, Kuthaje S. Bose, and Kodimoole S. Prasanna

Section 5 Surgical Therapies: History, Patient Selection, and Classification 171

20 History and Chronology of Development of Surgical Therapies for Vitiligo 173
Koushik Lahiri and Abhishek De

21 Patient Selection, Pre‐ and Postoperative Information in Surgical Therapies for Vitiligo 185
Nanja van Geel and Mats J. Olsson

22 Classification of Surgical Therapies in Vitiligo 193
James L. Griffith, Mohammed Al‐Jamal, and Iltefat H. Hamzavi

Section 6 Surgical Therapies: Tissue Grafting 209

23 Minigrafting for Vitiligo 211
Koushik Lahiri

24 Suction Blister Epidermal Grafting 225
Savita Yadav and Somesh Gupta

25 Thin and Ultra‐Thin Skin Grafts for Vitiligo 241
Imran Majid

26 Treatment of Leukoderma by Transplantation of Ultra‐Thin Epidermal Sheets
Using a Motorized Dermatome 249
Mats J. Olsson

27 Mesh Grafts for Vitiligo 257
Chakravarthi R. Srinivas and Reena Rai

28 Smash Grafting 261
Sumit Kar, Ajay Krishnan, and Sudhir Singh

29 Therapeutic Needling and Needling Micrografting 267
Khalifa E. Sharquie and Adil A. Noaimi

30 Complications and Limitations of Melanocyte Transplantation 273
Yvon Gauthier and Laila Benzekri

Section 7 Surgical Therapies: Cellular Grafting 279

31 Treatment of Leukoderma by Transplantation of Basal Cell Layer Suspension 281
Mats J. Olsson

32 Non‐Cultured Extracted Follicle Outer Root Sheath Cell Suspension Transplantation 293
Kanika Sahni and Somesh Gupta

33 Long‐Term Results of Non‐Cultured Epidermal Cellular Grafting in Vitiligo 299
Nanja van Geel, Sofie De Schepper, Hilde Lapeere, Barbara Boone, Boon Kee Goh, and Reinhart Speeckaert

34 Simplified Non‐Cultured Cellular Grafting 303
Boon Kee Goh

35 Novel Methods of Preparing Epidermal Cell Suspension for Transplantation in Vitiligo 309
Vishal Gupta, Sanjeev Gupta, Kanika Sahni, and Somesh Gupta

36 Management of Vitiligo: Setting Up a Tissue Culture Laboratory 317
Rafał Czajkowski, Małgorzata Maj, and Tomasz Drewa

37 Treatment of Leukoderma by Transplantation of Cultured Autologous Melanocytes 323
Mats J. Olsson

38 Transplantation of In‐Vitro‐Cultured Epithelial Grafts for Vitiligo and Piebaldism 337
Liliana Guerra, Sergio Bondanza, and Desanka Raskovic

39 Application of Lasers for Abrasion in Transplantation Procedures for Vitiligo 351
Gwang Seong Choi

40 Cell Delivery on Recipient Skin 357
Thomas Hunziker

41 Safety Concerns in Transplantation of In‐Vitro‐Cultured Cellular Grafts 363
Liliana Guerra, Elena Dellambra, Patrizia Paterna, and Somesh Gupta

Section 8 Special Issues in Medical and Surgical Therapies 369

42 Surgical Management of Vitiligo of Lips, Eyelids, and Genitals 371
Riti Bhatia and Somesh Gupta

43 Surgical Management of Acral Vitiligo 389
Munish Paul

44 Surgical Management of Leukotrichia 401
Amrendra Kumar

45 Surgical Treatments of Leukodermas Other Than Vitiligo Vulgaris 407
Mats J. Olsson

46 Ethnic Issues in Management of Vitiligo and Sun Protection 417
Haneol S. Jeong, Michelle Rodrigues, and Amit G. Pandya

47 Management Issues for Vitiligo in Children and Pregnant Women 427
Freya Van Driessche and Nanette Silverberg

48 Combination Treatments for Vitiligo 439
Anuradha Bishnoi and Davinder Parsad

49 Micropigmentation 451
Gurvinder P. Thami

50 Camouflage in Vitiligo 459
Chakravarthi R. Srinivas, Pradeep Balasubramanian, and C.K. Shashidharan Nair

51 Depigmentation Treatment for Vitiligo: Bleaching Cream, Laser, and Cryotherapy 469
Nanja van Geel and Monique R.T.M. Thissen

52 Future Directions in the Treatment of Vitiligo 475
Vishal Gupta and Somesh Gupta

53 Informed Consent 491
Mats J. Olsson

Index 495

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