Considering treatment for your vitiligo? You’ve likely heard about light therapy and topical steroids, but a lesser known form of treatment is skin grafting, a surgical process that uses your own healthy skin to stimulate repigmentation.
How does skin grafting work? And perhaps more importantly, does it hurt? Here’s what you need to know about this form of treatment.
What is skin grafting?
Skin grafting is a procedure in which healthy skin is removed from the body and applied to an area of vitiligo to support repigmentation. The healthy skin is also known as the donor site and is usually taken from the buttock or thigh. The area of vitiligo, also referred to as the recipient site, will have the top layer of skin removed.
At this point, you most likely have two burning questions. Does it hurt? And how much skin do you need? The good news is that a significant volume of donor skin isn’t required for skin grafting. In fact, in some procedures you can expect to treat an area up to five times as large as the donor site. Additionally, the skin that is taken from the donor site is often the very top layer of skin called the epidermis. This layer is only about as thick as a single sheet of paper and will regenerate on its own over time.
How skin grafting treats vitiligo
Let’s take a brief moment to talk about the science of why skin grafting works. At the base of the epidermis (the top layer of skin) there are cells sprinkled throughout called melanocytes. Melanocytes are responsible for producing melanin, which is what gives skin its color and is distributed throughout the epidermis. In vitiligo, the immune system is hyperactive and targets the melanocytes, blocking melanin production and resulting in the loss of pigment from the skin.
With skin grafting, melanocytes from the donor site are contained in the extracted skin and transferred to the recipient site, where they can resume melanin production in their new home. You might wonder what good that does when the immune system could still target these melanocytes. This is why dermatologists won’t recommend this treatment if you have active vitiligo, evidenced by expanding or new areas of vitiligo. If your vitiligo spots haven’t changed recently, then your immune system is likely calm and won’t attack the newly transferred melanocytes. A doctor can confirm how active or inactive your vitiligo is.
Different methods of skin grafting
We’ve been talking about skin grafting broadly, but you might be surprised to learn that there are several different types of skin grafting procedures that are available. Here’s a quick list of the options and what you should know about each one.
Punch grafts are one of the more commonly used techniques in skin grafting, mainly due to the procedure’s simplicity. During a punch graft, the doctor will remove a piece of skin that is typically 2 mm in diameter — smaller than the diameter of a straw —and transfer it to a depigmented area of skin that has also had a layer of skin removed. The name “punch graft” refers to the type of tool that is used to remove the skin sample, which can be described as a circular stencil. Potential side effects or complications that might arise from this technique are imperfect color matching, hyperpigmentation, raised scarring or immune reactions to the foreign skin.
Blister grafts are generally safe, easy to perform and low-cost. However, this procedure can be time-intensive. For a blister graft, suction is applied to the donor and recipient sites in order to form blisters, which are areas of skin that are raised and filled with fluid as a result of irritation. This process alone takes anywhere from 1-3 hours. After the blister has formed, the roof of the blister at the donor site is removed and transplanted to the recipient site where the blister roof has already been removed. With this technique, 65-100% repigmentation can be achieved in up to 80% of patients. Side effects and complications that may occur include hyperpigmentation of donor site, graft rejection and depigmentation surrounding the graft.
Split Thickness Skin Grafting
Split thickness skin grafting (SSG) can cover larger areas than the previous two treatment options, while also producing uniform pigmentation and even surfaces. This is accomplished by extracting the top layer of skin, creating slits in the extracted skin to produce a mesh that expands, and transferring it to the recipient site. However, this process comes with disadvantages, such as poor sensation in the recipient site, graft rejection and a longer period of postoperative wound care.
Cellular TransplantationCellular transplantation leverages laboratory techniques to separate individual melanocytes from the extracted donor skin, which is obtained through similar techniques as split thickness skin grafting. They are then prepared in a cell suspension, which is a process of cultivating cells in an environment that allows them to multiply. The cells are transferred directly to the recipient sites or incubated in a cell culture to generate more melanocytes before transplantation. As you can imagine, the latter option requires more lab resources and time before the transplant, but it also allows for the same amount of donor skin to treat much more depigmented skin. Currently, this procedure is considered the most safe and effective treatment for vitiligo but can be expensive.
What does the recovery process look like?
After the procedure, your doctor will give you specific instructions about postoperative care. You can expect to keep the skin graft dry and avoid activities that will stretch the graft for several weeks. Dressings on the donor and recipient sites will likely be worn for up to a week.
Who makes a good candidate for skin grafting?
As with many surgical procedures, there are guidelines to determine if someone is a good candidate for skin grafting as a treatment for vitiligo. One requirement is that vitiligo has to be stable, meaning that there haven’t been any new or expanding areas of vitiligo in the last 1-2 years.
Additionally, individuals with segmental vitiligo, or areas of depigmentation that are localized to one side of the body, typically make good candidates for skin grafting, achieving repigmentation 80-95% of the time without requiring further treatment.
How can I get started if I’m interested?
If you’d like to learn more about skin grafting and find out if you are a good candidate for skin grafting, talk to your dermatologist. Your doctor can help determine if your vitiligo is stable and discuss whether surgery would be the best option for you.
What has been your experience with skin grafting?
Disclaimer: This list is provided for informational purposes only. Please consult your dermatologist to determine the best treatment options for you.
Yong-hun Kim is a medical student from Rochester, Minnesota. He is interested in dermatology and believes in empowering others through information and education. In his free time, he enjoys cooking and rock climbing.