Surgical Therapies

Abstract

Vitiligo is a relatively common pigmentary disorder (affecting nearly 1–2 % of population) of great socio-medical importance. Depigmentation of the skin with the loss of melanocytes on histology characterizes this disorder. It is defined as a circumscribed, acquired, idiopathic, progressive, hypomelanosis of skin and hair, often familial and characterized by total absence of melanocytes microscopically. This definition excludes postinflammatory, chemically induced depigmentation, and those which are associated with melanoma, secondary to various dermatoses and after burns. A range of clinical phenotypes lead to varying degrees of morbidity. The cause of vitiligo remains unknown, although an autoimmune pathogenesis seems most likely. Treatment also remains difficult. A number of new therapies show significant potential. Vitiligo presents as sharply demarcated depig-mented macules, that can appear anywhere on the skin. There is a predilection for orifices – eyes, nostrils, mouth, nipples, umbilicus, and genitalia.¹ The natural history of the disorder is either that it spreads quite quickly (over months) and then is stable, or it relentlessly spreads over the body with time (over years). Sites of trauma (koebnerization), such as the elbows, may develop vitiligo.¹ Twenty-three to twenty-six percent of patients are children under the age of twelve.^2–4 It is the most commonly acquired hypomelanosis.⁵