title: Vitiligo surgical, laser, and alternative therapies: a review and case series.
abstract: BACKGROUND
  Vitiligo is a condition caused by the destruction of melanocytes, resulting in areas of skin without pigmentation. While many topical therapies exist for its treatment, not all patients respond to such treatments. Various surgical, laser and other alternative therapies are available for use as well.
  
  
  OBJECTIVE
  The objective of this review was to describe the various surgical, laser, and alternative therapies available for vitiligo. A literature review was conducted through Pubmed and Ovid using the search terms "Vitiligo treatment", "Vitiligo surgery", "Vitiligo laser". Since no articles were available about needling on both Pubmed and Ovid using the search criteria, individual articles were sought out through Google.
  
  
  RESULTS
  The literature review yielded many possible surgical interventions including autologous mini-punch grafting, suction epidermal blister grafting, split-thickness grafting, and cultured and noncultured melanocyte keratinocyte transfer. Laser options included the helium-neon and xenon-chloride lasers, with tattooing and needling serving as other options. While all the above techniques can provide improvement to pigmentation in vitiliginous patches, physician comfort and experience are important factors with regards to outcome. Our case series of four patients treated with the needling method yielded favorable results, with repigmentation rates ranging from 25-50%, with one patient having 90% repigmentation.
  
  
  CONCLUSIONS
  There are many surgical, laser, and alternative treatment options available for vitiligo when conventional medical therapy fails or for use in conjunction with medical therapies. Autologous mini punch grafting and needling both have minimal equipment requirements and are easy to learn. Physician experience and comfort play a large role in outcome and availability of services.
authors.affiliation: University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA. cin149@aol.com
authors.forename: Cindy
authors.initials: C
authors.lastname: Wassef
authors.forename: Adriana
authors.initials: A
authors.lastname: Lombardi
authors.forename: Sairah
authors.initials: S
authors.lastname: Khokher
authors.forename: Babar K
authors.initials: BK
authors.lastname: Rao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000529:Complementary Therapies / Q000379:methods*; D006801:Humans; D015603:Keratinocytes / Q000637:transplantation; D053685:Laser Therapy / Q000379:methods*; D008544:Melanocytes / Q000378:metabolism / Q000637:transplantation; D009339:Needles; D012880:Skin Pigmentation; D013653:Tattooing; D014820:Vitiligo / Q000473:pathology / Q000601:surgery / Q000628:therapy*