The concept of stability of vitiligo: a reappraisal

Abstract

Stability is taken as the most important parameter before opting for any transplantation technique to treat vitiligo. But, simultaneous donor site repigmentation and depigmentation of grafts at the recipient site has been noted. Similarly donor site depigmentation with complete repigmentation of the recipient area with pigment growing out from each graft has been observed. Successful repigmentation after regrafting in previous punch failure cases has also been reported. Koebner's phenomenon from history (Kp-h) and test grafting were the only available indicators to assess stability. It is quite ironic to note that even after four decades of experience in vitiligo surgery, there seems to be little consensus among workers regarding the optimal required period of stability. Moreover, the exact concept of stability in vitiligo is itself still not transparent and defined beyond doubt Overdependence on KpH or TG may be sometimes misleading in vitiligo. These two reveal the apparent clinical stability only and that may not be the true reflection of stability status of the disease at the molecular level. Antimelanocyte cytotoxic reactivity was observed among CD8+ TCC isolated from perilesional biopsies of patients with vitiligo. An attempt should be made to clearly fathom and define stability, not merely only on clinical ground but along with electron microscopy and histoenzymological analysis of the perilesional and nonlesional skin of vitiligo patients. Probably some growth factors which are responsible for both mitogenic and melanogenic stimulation of melanocytes should also be taken into account. Some serological test(s) could guide us to measure these growth factors.

Keywords: Vitiligo; vitiligo grafting; vitiligo stability.

Figure 1

Depigmentation of grafts in the recipient area of stable vitiligo (shown with arrow)

Figure 2

Repigmentation of the donor site in the same patient

Figure 3

Perigraft spread of pigment (shown with arrow)

Figure 4

Simultaneous spread of disease over thumb and knee (shown with starburst sign)

Figure 5

Minigrafting on dorsum of foot, first session (shown with blue arrow)

Figure 6

Second session, perigraft repigmentation from grafts of previous session (shown with yellow arrow)

Figure 7

Appreciable repigmentation (yellow arrow). Reactivation of disease on the same anatomical site.(shown with red starburst)

Figure 8

Punch grafting on medial aspect of left leg

Figure 9

Spontaneous repigmentation of medial aspect of right leg

Figure 10

Punch grafting on right leg (shown with blue arrow). Spontaneous repigmentation over left leg (shown with yellow arrow)