Pigmentary correction of piebaldism by autografts. II. Pathomechanism and pigment spread in piebaldism.

Human piebaldism is an expression of neural crest component abnormality that is classically inherited dominantly and is probably heterogeneous genetically. Though usually a stable cutaneous condition, spontaneous pigmentation in hypomelanotic tracts is known. Here, pigmented skin around the axilla was transplanted to hypomelanotic areas in two patients with piebaldism. The cutaneous autografts, whether full-thickness punch grafts, split-thickness shave grafts, or epidermal suction grafts, retained their capacity of pigmentation. Moreover, there was spread of pigmentation around the grafts. Strategic placement of cutaneous autografts in the most conspicuous hypomelanotic areas of piebald persons can improve their appearance.