Punch grafting as a treatment for residual lesions of vitiligo

Abstract

Sixty patients having 70 residual lesions of vitiligo not responding to medical treatment for a period of at least 4 months were subjected to punch grafting. The donor skin was taken from the buttock, thigh or leg of the same patients with a 4 mm skin biopsy punch and placed on the recipient area prepared by excising the vitiliginous skin with a 3 mm skin biopsy punch. The recipient areas were placed at a distance of 1 cm from the margin of the lesion and 1-2 cm from each other. Out of total of 280 grafts applied in these lesions, 256 (91.1%) gfafts were successful, while 21 grafts were rejected, 2 grafts became depigmented and 1 graft developed into a keloid. The pigment spread centrifugally around each of the successful grafts and 76% of grafts showed a pigment-spread of more than 6 mm within 6 months. Pigment continued to spread even in the grafts applied 2 years ago and the maximum spread so far has been 22 mm. The pigment-spread was faster in the lesions situated on the trunk, neck, face and proximal parts of the extremities. Lesions on the dorsal aspects of hands, fingers, feet and maleoli were slow to repigment. Treatment of the lesion with topical psoralen followed by sun exposure led to a faster spread of pigmentation.