Micropigmentation in Vitiligo of Lateral Lower Lip

Sir,

Vitiligo, however small, is of major significance to patients who have it and it can cause severe emotional distress if left untreated. Vitiligo of the lateral lower lip is a specific type of lip vitiligo which forms about 16% of all vitiligo patients.[1] It starts as a tiny dot at the lateral part of the lower lip and spreads medially as a linear streak along the vermillion border. Even though, various treatment modalities such as blister grafting, ultrathin grafting, punch grafting have been described for lip vitiligo, none of them are effective for vitiligo of lateral lower lip.

We analysed data from the files of the Department of Dermatology, Amala Institute of Medical Sciences, Thrissur. All patients of vitiligo lateral lower lip who had undergone micro-pigmentation between January 2006 and December 2011 were included in this study.

The procedure included an informed consent, cleaning with normal saline, tumescent anaesthesia with injection 2% of xylocaine, tattoo pigments brown and black were mixed in a proportion of 4:1, actual micro-pigmentation was done with number 10 pony sewing needle after appropriate sterilisation in cidex solution, micro-pigmentation was done until the colour matched the surrounding skin, pressure was given with gauze for about 2 min to stop bleeding, after the procedure the area was cleaned with saline, immediate side-effects such as bleeding and haematoma were noted.

A total of 30 patients had undergone micro-pigmentation during the study period, of which 18 (60%) were females and 12 (40%) males in the age range of 14-54 years (average 34 years). The duration of the disease was from 4 months to 11 years (5.7 years). 13 patients (43%) had bilateral lesions, whereas 17 (57%) had unilateral lesions. All the patients (100%) were satisfied with the immediate results. None of the patients had any immediate side-effects. When the patients had been reviewed at 3 weeks, two patients (6.7%) complained of loss of pigment for which touch up micro-pigmentation was done. None of the patients had any other side-effects. Only 27 patients had completed 1 year after the procedure. Retention of pigment was assessed by contacting the patients over the telephone and all (100%) the 18 patients we could contact reported to have excellent retention of pigment [Figure 1].

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Figure 1

Vitiligo of lateral lower lip before and after micro-pigmentation

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One of the limitations of micro-pigmentation is getting an exact colour match. Since in our patients the lesions were on the lateral side, where the lip is darker with some amount of shadow, we were able to get excellent colour matching and patient satisfaction. Reaction to tattoos can include allergic hypersensitivity granulomatous, lichenoid and pseudolymphomatous types.[2] None of our patients had any of these type of reactions. This may be because we have used only black and brown pigments and the reaction are seen to be more common with red, yellow, green and blue pigments.[3]

Micro-pigmentation is a safe, effective and cosmetically acceptable option for vitiligo of lateral lower lip. It is a relatively easy procedure with immediate results and fairly long lasting results.