Repigmentation of vitiligo patches by transplantation of hair follicles

Vitiligo surgery is basically aimed at cosmetic camouflage because of the social stigmata
attached to the disease. The color contrast in dark-skinned races makes it imperative that ideal
treatment of vitiligo should result in an appropriate color match without any scarring over
these patches.
Various surgical procedures are practiced for treating stable vitiligo patches, e.g. punch graft,
1
Thierschs graft, 2 blister-induced epidermal graft, 3 full-thickness skin graft, 4 autologous
melanocyte transplants, 5in vitro cultured epidermal grafts bearing melanocytes, 6
micropigmentation, 7 and dermabrasion with S-flourouracil application. 8 All of these
techniques induced satisfactory repigmentation with some drawbacks.
For repigmenting vitiligo patches, we have used hair follicle(s). A very small strip of hairs
was taken from the occipital area. Single hairs were separated from the strip, and were
implanted into the vitiligo patches by an 18-gauge needle. 9
Three patients with five vitiligo patches constituted the sample population. All of the five
patches were located in the hair-bearing areas. Of these five, one was located over the beard
area, and two each on the forearms and legs. The hairs were implanted 35 mm apart from
each other. The implantation was followed by PUVA-SOL therapy. After implantation of the
single hairs, repigmentation of the vitiligo patches started between the fourth and seventh
weeks. The spread of repigmentation continued up to 4 months and the patches became
practically invisible after 6 months.
The pigment from each hair follicle gradually blended with the pigment of the adjacent hair
follicles. Small, achromic areas were noticed in some places, however. This drawback can be
corrected by retransplantation of single hairs into these areas.
All of the five vitiligo patches were repigmented with excellent color matching. There was no
scarring, cobblestoning or stuck-on appearance. Achromic areas and depigmented haloes
around repigmented patches were further corrected by single hair transplant.
The repigmentation of the vitiligo patches can be best explained by the highly active
melanocytes in the hair follicles of the scalp which migrate into the basal layer of the
epidermis. 10 The patients were followed up for 12 months after the procedure with
persistence of color.
The procedure suffers from a distinct drawback, however, in that it cannot be practised over
non-hair-bearing areas, such as the face, because of cosmetic reasons.
The procedure may be a valuable adjunct for the treatment of achromic lines, spots and
haloes in and around the vitiligo patches treated by other surgical methods. Therefore, it acts
as a filler technique and appears to be quite promising.