HISTORY:

Dr. Kahn has treated burn patients for many years. He and others observed that some burn patients heal with loss of pigment on the fingers, hands, wrist, feet and ankles. This problem can be very distressful to some of these patients. In the early 1980's Dr. Kahn and his colleagues began repigmenting nonpigmented areas in burn patients. Gradually their techniques were modified and improved and their initial results were published in the Journal of Burn Care and Rehabilitation (1991;12:468-473). More extensive long term results were published in Burns (1996;22:552-554).

Dr. Kahn thought that the technique which he found to be so effective for repigmenting the burn patient might be equally helpful for those suffering from vitiligo. Dr. Kahn's application of his technique to vitiligo was initially reported in the Journal of the American Academy of Dermatology (1993) and most recently in Dermatologic Surgery (1998;23:635-367). Recently, Piebaldism has been successfully treated.

METHODS:

Treatments have been performed in a medical office, an out-patient surgi-center, as well as at a hospital. Usually the procedures are performed on an outpatient basis. Occasionally some patients need to stay in the hospital. If repigmentation is to be on the legs or feet, then several days of hospitalization with complete bedrest and elevation of the legs is necessary.

The surgical technique requires anesthesia. The type of anesthesia depends, to some extent, on the size and location of the areas to be repigmented. Some patients need general anesthesia, while others may need only regional and/or a local anesthetic.

The area of skin lacking pigmentation must have its outer layer (epidermis) removed. This outer layer is removed by using a motorized "sanding" device or a Erbium YAG laser. Great care is taken not to injure the underlying deeper layer of skin (the dermis) in order to avoid scarring.

Once the skin's outer layer has been removed, melanocytes are then transplanted. The melanocytes are obtained by removing the top layer of normal skin (the epidermal graft) from a normally pigmented area of the body. These grafts are 0.006-inch (0.1524-mm) or thinner in thickness. The width and length varies depending upon the size of the area to be repigmented. The graft is then placed over the area that had been sanded (dermabraded or prepared with the laser) and secured to prevent any movement of the graft.

The use of the Erbium YAG laser makes it possible to repigment areas such as the eyelid and penis that we could not previously treat with surgery.

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RESULTS:

Of the operations performed, all patients have regained pigment. (89% have regainged 95-99% of the pigment). In the other 11%, the repigmentation ranged from 50% to 95%. The color match (assessed by the patient and Dr. Kahn) was nearly perfect in most patients who have been followed for more than 6 months. During the first 6 months following the procedure, the repigmented regions are hyperpigmented (darker in color than the surrounding skin). Gradually, over the next 6 to 12 months the color of the transplanted area approaches a more normal color.

The areas treated have been the face, neck, arms (including the hands and fingers), breast, chest, back, abdomen, and the legs. So far, no patient has developed scarring. One patient (more than a year after his operation) developed rapid and progressive "activation" of his disease and went on to depigment 99% of his body including the area that had been treated surgically. To the best of our knowledge, no other patient has lost any regained pigment.

Questions? Send your questions to Dr. Kahn.