Re-pigmentation is evaluated in phases of speed and pattern. This evaluation will help us to best kind of treatment plan.
SLOW RESPONDER: If the re-pigmentation is delayed or incomplete even after 6 to 9 months of having stable vitiligo and continuous treatment, such patches are termed as slow responders. It may be due to less than sufficient cell reservoirs; there is slowness in the re-pigmentation. In such situations, we advise micro-needling along with growth factors or cells, targeted phototherapy, and in some cases, cell transplantation
Re-pigmentation is evaluated according to the peculiar pattern of pigmentation onset after the particular treatment.
PERIFOLLICULAR: Usually seen after medical management over the patch with black hairs. Tiny dots of pigments appear at the root of hairs, gradually increasing in size and joining together to become a giant patch of pigmentation. The speed of pigmentation is faster. They are sometimes seen after cell transplantation and micro-needling techniques.
DIFFUSE: This is also seen primarily on the hairy area or the patch after cell transplantation. It can also be the outcome of medical management and micro-needling techniques. Suddenly a more extensive area of pigmentation starts visibly. It is also a faster version of pigmentation.
MARGINAL: The pigmentation starts from the border. The size of the patch reduces, but the shape sometimes remains stagnant. It is the slowest version of pigmentation but the very stable version of pigmentation. It can be possible due to all types of treatments. They were observed over the joints and acral area with no reservoirs.
COMBINED: A combination of 2 or 3 of above mention patterns can occur. Usually observed over larger patches.
REFRACTORY: In this variety, one can see darker borders of the vitiligo patches, along with darker islands of pigmentations that don’t increase in size despite continued medical treatment. The resistant white area remains white or reddish-pink. It occurs in a patch with a limited reservoir, which cannot contribute the required pigment cells to replenish the lost ones.