What should I do if vitiligo does not improve with laser treatment?

In a study of 0.8 mm micro-punch grafting, 78.7% showed more than 75% pigment recovery.

An analysis of 230 cases of vitiligo that no longer responded to excimer laser showed a treatment success rate of 78.7%.

In particular, 67.4% achieved more than 90% pigment recovery with a single surgery.

Results varied significantly by body area.

That is, the most favorable treatment response was seen on the face and neck, while the hands and feet showed relatively lower response.

Side effects included pigment mismatch and cobblestone appearance changes, but some improved naturally over time.

The 0.5 mm method has the advantage of reducing scarring and surface unevenness.

The method using a 0.5 mm punch is called the skin seeding technique because grafts can take without aligning the epidermis and dermis direction individually.

With 0.5 mm, the grafts are smaller, so they need to be placed more densely, which may slightly increase the surgery time.

On the other hand, donor site marks are barely noticeable, and the incidence of cobblestone appearance is about 2 to 4%, lower than with 0.8 mm.

However, the number of melanocytes contained in each graft may be smaller than with 0.8 mm, so in practice, the two sizes can be used selectively depending on the location and characteristics of the lesion.

The most important condition is that the vitiligo is sufficiently stable. Surgery is generally considered for stable vitiligo where no new lesions have appeared and existing lesions have not enlarged for at least 12 months. Some reports indicate that the risk of surgical failure is about 7.7 times higher when the stable period is less than 6 months.

Additionally, if there is a Koebner phenomenon, where new vitiligo develops after trauma or friction, surgery itself may trigger new lesions, so caution is needed.

Treatment response was relatively better in the following cases:

- Vitiligo on the face and neck

- Lesions stable for more than 12 months

- Segmental vitiligo

- Younger patients

Conversely, vitiligo on the hands, feet, or joint areas, and non-segmental vitiligo, have relatively lower treatment success rates, requiring more careful judgment.

In particular, non-segmental vitiligo showed about 6 times higher risk of surgical failure compared to segmental vitiligo.

Yes. Since December 1, 2019, health insurance has been applied to micro-punch grafting for vitiligo.

Full-thickness skin grafting using a micro-punch is recognized as a covered benefit when performed for vitiligo, and autologous epidermal grafting using suction blisters is also covered for vitiligo treatment.

However, health insurance coverage is primarily applied to vitiligo on exposed areas such as the face, hands, feet, and joints, and the coverage criteria may vary depending on the surgical site and area.

With health insurance coverage for micro-punch grafting, patients who have not responded sufficiently to UV therapy can now more realistically consider surgical treatment.

Ultimately, micro-punch grafting is not a surgery performed simply because laser treatment has failed, but a treatment option to restart pigment recovery in sufficiently stable vitiligo.

In particular, if there is no further improvement with excimer laser in areas with good treatment response, such as the face and neck, surgical treatment can be considered together.