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Quick and effective solution for perigraft halo in difficult cases
*Corresponding author: Dr. Aneet Kaur, Department of Dermatology, Maulana Azad Medical College, New Delhi, India. kaur_aneet@ymail.com
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Received: ,
Accepted: ,
How to cite this article: Kumar A, Bagrodia A, Kaur A, Relhan V. Quick and effective solution for perigraft halo in difficult cases. J Cutan Aesthet Surg. doi: 10.25259/JCAS_35_2025
Abstract
Surgical management, especially grafting, can provide an effective solution to long-standing stable vitiligo in most cases. However, the resultant perigraft halo can be difficult to manage at times, as patients are not willing to undergo repeat surgery, and methods such as phototherapy, 88% phenol, microneedling, and 5-fluorouracil can fail. We herein describe a simple, quick, and effective solution for the management of perigraft halo that failed to respond to other modalities.
Keywords
Dermatosurgery
Motorized punch
Perigraft halo
Vitiligo
PROBLEM STATEMENT
A 23-year-old man underwent suction blister grafting (SBG) 10 months ago for focal vitiligo on the left side of his lower lip. He was, however, bothered by the perigraft halo which had subsequently developed [Figure 1]. The perigraft halo had failed to repigment despite repeat SBG, phototherapy, 88% phenol, microneedling, and 5-fluorouracil. The patient did not consent to tattooing and wanted a permanent solution.
RECOMMENDED SOLUTION
Using the hair transplant follicular unit extraction (FUE) motorized punch (0.7 mm), we punched multiple areas of skin in the perigraft halo to the mid-dermis level after achieving local anaesthesia. Care was taken not to place two punches <1–1.5 mm apart so that healing is faster without any residual scarring [Figure 2]. This method also allowed us to remove leukotrichia simultaneously. The area was left to heal with secondary intention. After 1 week, the site had almost completely healed with a reduction in the depigmented area. Further two sittings allowed us to achieve complete repigmentation of the perigraft halo [Figure 3]. FUE was done 6 months after SBG and since the repigmentation started occurring around the areas that were punched, we were sure it was because of FUE and not SBG. Surgical excision and punch grafting of a vitiligo patch are known modalities for the treatment of recalcitrant vitiligo.1 However, the result may not be cosmetically acceptable to the patient and they are time-consuming. We overcame these limitations using a small-sized (0.7 mm) motorized punch, which removed only small areas of depigmented patch at a time and overcame complications such as cobblestoning and scarring. Furthermore, post-inflammatory hyperpigmentation induced by therapeutic trauma might have aided in achieving repigmentation.2 However, the results of this method may not be uniformly reproduced in all patients due to the heterogeneous nature of vitiligo in patients of different ethnicities.
- Pre-operative picture of perigraft halo near left side of lower lip.
- Post-operative picture showing punched areas of depigmented skin in healing stage.
- Complete repigmentation of perigraft halo after 3 sittings.
Authors’ contributions:
Abhinav: Concept, design, data acquisition, manuscript review. Anjali Bagrodia: Design, literature search, manuscript preparation, manuscript editing, manuscript review. Aneet Kaur: Concept, design, literature search, data analysis, manuscript preparation, review and editing, guarantor. Vineet Relhan: Concept, design, manuscript editing and review.
Ethical approval:
Institutional review board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Surgical excision and primary closure for the treatment of lip vitiligo. J Cutan Aesthet Surg. 2011;4:216-7.
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- Effect of different types of therapeutic trauma on vitiligo lesions. Dermatol Ther. 2017;30:2.
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