Preservation of Repigmentation in Grafted Areas Despite New Lesion Development and Spread in Segmental Vitiligo: A Retrospective Study of 50 Patients

Patients with segmental vitiligo who initially improve after surgical repigmentation but later develop recurrent or newly progressive lesions are rarely encountered in sufficient numbers, and the anatomical distribution of recurrence remains poorly characterized. We retrospectively reviewed 50 patients with segmental vitiligo who underwent surgical repigmentation using the skin seeding technique with adjunctive excimer and topical treatment and later revisited with recurrent or newly progressive depigmented lesions. Clinical records, serial clinical photographs, immediate postoperative photographs, and Wood's lamp images were reviewed to classify lesions within previously repigmented treated areas or at adjacent or noncontiguous sites within the same segment. No true recurrence was identified within previously repigmented treated areas in any patient (0/50). Recurrence occurred as adjacent-only progression in 16 patients (32%), noncontiguous-only progression in nine patients (18%), and both in 25 patients (50%). Median intervals from first surgery to first and last observed recurrence were 8 and 21 months, respectively. At first surgery, 18 patients (36%) had active disease and 32 (64%) had quiescent disease. These findings describe preservation of repigmented grafted portions despite progression elsewhere. This retrospective observation under combined treatment requires further validation and does not establish an independent protective effect of surgery.