Consensus-based guidelines for surgical management of vitiligo, by Vitiligo Task Force, IADVL Academy 2024- 2025

Background Surgical management is an important option for patients with stable vitiligo unresponsive to medical therapy, yet standardised guidance on its practice has remained limited. Objective To develop consensus-based, evidence-informed recommendations for the surgical management of vitiligo tailored to clinical practice in India, but relevant across diverse settings. Methods Key domains of vitiligo surgery lacking uniform guidance were identified through literature review and preliminary discussions. Draft statements were circulated among a purposively selected panel of expert vitiligo surgeons. Using a modified Delphi process, experts rated statements over five iterative rounds. Consensus was defined as a mean Likert score ≥3.75. Results The final consensus addressed patient selection, stability criteria, contraindications and minimum age considerations; preoperative evaluation and counselling; anaesthesia choices; determinants guiding selection of tissue versus cellular techniques; and recommendations for surgery at special sites. Technical guidance was provided on recipient-site preparation, donor harvesting, trypsinisation, centrifugation, use of inhibitors and wash media, and postoperative dressing. The panel endorsed non-cultured epidermal suspension (NCES) as the preferred method for large lesions, highlighted role-specific techniques for special sites and recommended dressings to remain undisturbed for 5–7 days. Adjunctive therapies such as phototherapy and topical tacrolimus were considered beneficial. Management of postoperative complications, including perilesional halo, was also addressed. Limitations Some recommendations are based on expert consensus due to limited high-quality evidence. Conclusion These consensus-based guidelines provide practical recommendations across the continuum of vitiligo surgery, aiming to harmonise practice, improve outcomes and support individualised decision-making. They also highlight areas where further research is needed to refine standards of care.