Description And Treatment Of Vitiligo

Vitiligo is a complex disease associated with selective and progressive loss of melanocytes from epidermal basal layer resulting in white patches, commonly on the skin and occasionally on mucosae. It is also known as leukoderma or phulwari in India. The condition is non-contagious and asymptomatic but is associated with a significant psychosocial implication leading to an exaggerated sense of humiliation, loss of self-esteem and job discrimination among patients. Worldwide prevalence of vitiligo is around 1%, whereas it is more common in India with a prevalence of around 4% (range- 0.46% to 8.8%) [1, 2].
The clinical features of vitiligo are variable, initially starting as hypopigmented and then depigmented macules, patches and widespread
Although medical treatment is the mainstay of treatment, it is not uniformly effective in all patients and a residual lesion further requires surgical intervention to achieve complete repigmentation. The key principle of treatment is to induce repopulation of active melanocytes that are able to migrate into, proliferate, and thus repopulate the depigmented skin. The proper selection of cases for surgical therapy is of paramount importance and the stability of the vitiligo is taken as the most important parameter before opting for any transplantation technique. Various authors have recommended different periods of stability varying from 4-months to 3-years, but none of these criteria are based on the evidence obtained from a systematic
Dermabrasion was done until tiny pinpoint bleeding spots were seen indicating the dermo-epidermal junction and was extended 5-mm beyond diseased margin to prevent halo phenomenon. The denuded area was washed with PBS and covered with a PBS moistened gauze piece. The NCES (in subgroup A) and the 1:1 combination of NCES and NDCS (in subgroup B) were carefully transferred to a tuberculin syringe. Using 18-gauge needle, few small drops of suspension were placed over the denuded surface and were evenly spread. This was covered with sterile Vaseline gauze (Unilever, London, UK) or Bactigras dressing (Smith & Nephew Pty Ltd, Victoria, Australia) after washing with NS. Few more drops of suspension were placed over this gauze and spread evenly. After washing with normal saline, a meshed collagen sheet (Kollagen M, Eucare pharmaceuticals, TN, India) was placed over the gauze with suspension. This was then covered by a small gauze piece moistened with PBS. Tegaderm (3M Medical, MN, USA) was placed to help form an artificial blister which would hold melanocytes with PBS over the recipient site. At difficult areas, such as lips, surgical glue was used to hold Tegaderm in place. The surgical pad dressing was done and fixed using elastic plaster (Dynaplast, Johnson & Johnson, NJ,