A 35-year-old woman with vitiligo is evaluated for surgical candidacy. She has had stable patches for 2 years, no new lesions, and positive Koebner's phenomenon currently. What is her surgical suitability status?

• A Suitable — stability for 2 years is sufficient
• B Not suitable — positive Koebner's phenomenon is a contraindication to surgical intervention ✓
• C Suitable — Koebner's phenomenon is only relevant for the trunk, not limbs
• D Suitable — surgery can be performed with concurrent immunosuppression

Explanation

For vitiligo surgical procedures (split-thickness grafts, suction blister grafts, melanocyte transplantation), strict criteria must be met: disease stability for at least 1-2 years, absence of the Koebner phenomenon, absence of active depigmentation, and absence of dermographism. A positive Koebner's phenomenon indicates the disease is still active/unstable and is an absolute contraindication to surgery, as trauma from the procedure would trigger new lesions. Stability alone is necessary but not sufficient if Koebner's is present.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.