Therapeutic success of epidermal grafting in generalized vitiligo is limited by the Koebner phenomenon.

Eighteen patients with vitiligo (two with localized type, five with segmental type, and 11 with generalized type) were treated with an epidermal graft using the roof of a suction blister. In all patients with localized and segmental lesions and in seven with generalized lesions, successful repigmentation without scarring was observed at the grafted sites approximately 2 to 3 weeks after grafting, and a subsequent two- to threefold expansion of the pigmented area occurred within 3 to 4 months. On the other hand, no repigmentation could be achieved in four patients with generalized vitiligo in whom depigmentation (i.e., the Koebner phenomenon) occurred at the donor sites. Our results suggest that the Koebner phenomenon occurs in an all-or-none pattern only in patients with generalized vitiligo. Thus, although epidermal grafting is a simple and useful method, successful repigmentation at the recipient sites depends on the selection of patients with localized lesions in whom the Koebner phenomenon does not develop.