Surgical Management of Vitiligo
Edited by Somesh Gupta, Mats J. Olsson, Amrinder J. Kanwar, and Jean-Paul Ortonne. Pp. 304. Blackwell Publishing, Malden, Mass., 2006. Price: $179.95.
Vitiligo is a cosmetically debilitating, depigmenting condition that has long intrigued researchers and physicians worldwide. Fortunately, it is a relatively rare condition; unfortunately, treatment is rarely uniformly successful. During the last two decades, outstanding new therapies have emerged to treat it. Professors Somesh Gupta, Mats J. Olsson, Amrinder J. Kanwar, and Jean-Paul Ortonne are to be commended for amassing a comprehensive, 38-chapter textbook exploring the surgical management of vitiligo. This text represents the research and scientific studies of 48 experts from 13 countries. They provide a concise description and overview of the disease. All of the treatment topics presented deal with the surgical management of vitiligo, which goes beyond the typical medical therapies seen in most dermatological practices.
The text begins with an explanation of the pathogenesis of vitiligo and then launches into an impressive breadth of specific surgical options. Section 3 devotes nine chapters to tissue grafting, while section 4 encompasses six equally impressive chapters on cellular grafting. No textbook is perfect, and multiauthored ones can be uneven in consistency. This text lacked substantial information on excimer lasers, one of the few treatments that have some success in repigmenting patches of vitiligo. Although excimer lasers are a widely accepted option, they are mentioned only briefly in the final section, under Miscellaneous.
Overall, the book provides organized, well-written, and well-referenced chapters that provide insight for physicians as to what surgical modalities are available for vitiligo. Most importantly, it offers hope for patients that alternatives exist for their disfigurement. We believe, however, that it is probably a rare situation where one would encounter a patient with vitiligo who requires surgical intervention, such as skin grafting or melanocyte transplantation. Ironically, the future may arise from the skin itself. Stem cell technology in rodents has been successful in reprogramming new adult skin cells to embryonic form, by way of inserting four genes into a mature skin cell.
Surgical Management of Vitiligo provides a fine, comprehensive review of this disfiguring disease, though the need for surgical treatment or for a plastic surgeon to incorporate this into his or her practice is likely to be rare. While it provides a brilliant summary of surgical options, the book more likely serves as a handy reference for dermatologists and plastic surgeons, offering the ability to educate patients about the other treatment options for this disease.
Gervaise L. Gerstner, M.D.
Alan Matarasso, M.D.
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