Clinical Scenario

Segmental vitiligo is a distinct subtype with a unilateral, dermatomal distribution. It tends to progress rapidly in its early phase before stabilising. Repigmentation is notoriously difficult to achieve in later stages, making the timing and selection of treatment especially consequential.

Previous Treatment — Goals Not Reached

The initial approach for segmental vitiligo involves early initiation of NB-UVB phototherapy (or excimer laser for localised lesions) combined with systemic steroids and a topical calcineurin inhibitor. The intended outcomes — halting disease activity and achieving repigmentation of the lesions — were not met.

Documented failure of this medical treatment line is the trigger for the next structured protocol.

Next-Step Approach (Partial Overview)

Once medical interventions have been tried and have failed in stable segmental vitiligo, surgical options represent the next therapeutic step. Whether certain individual factors are present — such as the existence of a melanocyte reservoir — influences the likelihood of a successful outcome.

The full protocol details which surgical approach or approaches apply, and under what conditions. That complete structured guidance is available via the link below.

References

DOI: 10.1111/jdv.19450

This is especially important in segmental and acral vitiligo, where repigmentation is notoriously difficult in later stages.

Surgery should be reserved for patients with SV and other localized and stabilized forms of vitiligo (non-segmental) after the documented failure of medical interventions.

The presence of melanocyte reservoir in the form of pigmented hairs improves the likelihood of success.

Several techniques exist, including punch grafting, suction blister grafting, non-cultured epidermal cellular grafting and cultured epidermal cellular grafting.

View source ↗

Segmental Vitiligo: What to Do When NB-UVB and Medical Therapy Have Not Worked

References