RE: Koebner phenomenon in vitiligo after suction blister epidermal grafting

As a researcher in melanocyte transplantation procedures (MTP) in vitiligo, I read with interest the article written by Wei Liu and Dong-Lai Ma, with its impressive image.(1) It is important to note that MTP comprehends a group of well-established procedures, all of which are best suited for stable cases of the disease (the most current period of stabilization is one year).(2) This patient selection criteria is crucial for the success of the procedure.(3) Once patients with Koebner phenomenon (KP) are more likely to present disease activity, they tend to have poor surgical outcomes. Disease activity and KP sometimes are hard to detect in the preoperative phase, and dermatologists must be aware of signs such as trichrome vitiligo and confetti-like depigmentation,(4) and follow-up the patient with photographic registers to assess the stability, when necessary.(2) Mini-grafting tests may also be performed in dubious cases. Furthermore, to minimize side effects, it is essential to choose hidden areas (such as inner thigh) as a donor site. Choosing surgical techniques with higher donor/recipient area ratio (such as melanocyte-keratinocyte transplantation procedure with ratio up to 1:10) can also reduce the skin area of this unpleasant side effect.