Vitiligo is a skin disorder, most often auto-immune, which is caused by unknown reasons and is characterized by the loss of pigmentation. Technically, the loss of pigmentation happens due to the deficiency in melanocytes, which prevents it from producing the necessary amount of melanin.
For the patients with vitiligo the problem of camouflaging is painstaking. The areas that are prone to the appearance of white patches include face (lips, nostrils, and eyes), arms and hands, legs, feet, and genitals. Since there are no medications for full and irreversible treatment of this disease and the cosmetic covering is not always easy, the procedure of micropigmentation (also called corrective repigmentation), offers convenient and the most reasonable solution.
It is worth mentioning that the PMU artist must not take the responsibility of diagnosing vitiligo or making any conclusions about the way it’s going to progress. For one thing, this disease takes a lot of medical tests to be identified. It can easily be confused with other dermatological conditions, for example, Tinea versicolor, secondary syphilis, etc. For another thing, the state of vitiligo defines whether the micropigmentation treatment is feasible.
Only patients with stable vitiligo qualify for micropigmentation, otherwise they risk developing a Koebner phenomenon; the development (or the further spreading) of vitiligo at the site of physical injury, i.e. cuts, abrasions, or in the given case the wounds from the tattoo needle. The non-progressive state of vitiligo is usually defined as the state when new white spots have ceased to appear and the existent ones aren’t getting larger, however, sometimes the disease can progress without obvious signs, thus the need for an artist to collaborate with the patient’s dermatologist.
Prior to the procedure the informed consent should be signed with the patient, stating that the micropigmentation of vitiligo is a multiple-sessions treatment extended in time, as layered pigment application is required for the most satisfactory results. A patch test is vital and is performed on a small, hardly noticeable area before the actual treatment. Firstly, it helps to instill patient’s confidence in the procedure, and secondly, it makes the artist more assured of a proper color match.
The first step of the corrective repigmentation procedure is to eliminate the contrast between the borders of the vitiligo marks and the central parts, which are usually much lighter. Light pigment is placed on the edges of these marks and beyond them, blending into the unaffected areas.
The next step is to scatter the pigment throughout the discolored spot. The single needle technique is preferable to the use of a larger cluster as it allows the creation of more realistic look by blending the existent strong blue undertone with pink or yellow tones (the latter will create a warmer color). Darker hues, consequently, will darken the area.
The final step is to blend the recreated color with the surrounding skin tones. It is easier achieved in patients with darker and ethnic skin and more complicated in vitiligo patients with fair complexion. Although pigments tend to lighten with time, it is recommended to start every session with lighter hues and then proceed with the darker ones rather than to overtreat and wait for normal color lightening.
The complications that are possible after the micropigmentation of vitiligo include the exacerbation of the disease, koebnerisation, chronic granulomatosis reactions and allergy to the injected pigment, secondary infection and color mismatch.
Corrective repigmentation of vitiligo is normally a safe procedure, however, people with a medical history of psoriasis, herpes simplex virus infection or HIV positive do not qualify for the treatment.