Beyond Topicals: Surgical Solutions for Vitiligo

While first-line treatments for vitiligo primarily include medical therapies, procedural interventions are emerging as valuable options for patients with recalcitrant or refractory vitiligo. In a discussion at the 2025 South Beach Symposium, Nada Elbuluk, MD, MSc, an associate professor of dermatology at the University of Southern California and founding director of their Skin of Color and Pigmentary Disorders Program, provided valuable insights into procedural treatments for vitiligo.

Elbuluk emphasized that "medical treatments for vitiligo are still our first- and second-line therapy," reinforcing the importance of topical immunosuppressive agents, such as corticosteroids, calcineurin inhibitors, and JAK inhibitors, often in combination with phototherapy. These remain the primary treatment strategies for managing active vitiligo. However, when patients exhibit refractory disease—either failing to respond adequately or plateauing in their progress—alternative interventions may be necessary.

For such patients, procedural treatments become a viable option. Elbuluk highlighted the importance of ensuring disease stability before considering surgical interventions, stating, "For these individuals, you also want to make sure they have no new or worsening lesions for at least 12 months." Stability is a crucial criterion, as ongoing disease activity could compromise the success of surgical procedures.

Among the available procedural treatments, melanocyte-keratinocyte transplantation (MKTP) represents the most advanced technique. This autologous procedure involves harvesting melanocytes and keratinocytes from unaffected skin, typically from the lower half of the body, and grafting them onto depigmented areas. "There are new technologies now that allow for this to be done on site, same day, all within a short, confined time period," Elbuluk noted, highlighting the significant progress in making this procedure more accessible and efficient.

As procedural options continue to evolve, Elbuluk expressed optimism regarding broader insurance coverage for these treatments. Expanding accessibility and affordability will be critical in ensuring that patients with stable, treatment-resistant vitiligo have more effective therapeutic options in the future. With ongoing advancements, procedural treatments are likely to play an increasingly important role in the comprehensive management of vitiligo.

Dermatology Times staff are onsite at the Loews Miami Beach Hotel for South Beach Symposium 2025. Subscribe to our eNewsletter for the latest in expert insights, exclusive interviews, and late-breaking data.

To read and listen to more of our conference coverage, click here.