The treatment of vitiligo includes both medical and surgical modalities, whose goal is to restore melanocytes to the depigmented skin so that the epidermis restores back to normal morphology and functions. Although medical treatment is the mainstay of treatment, it is not effective all and residual lesions need augmented surgical treatment for further completion of repigmentation. Also there are certain areas that are difficult to repigment such as vitiligo patches on joints and bony prominences, lips, genitalia, dorsum of hands and feet especially fingers and toes. Proper selection of cases for surgical therapy is of paramount importance and stability of vitiligo is taken as the most important parameter before opting for any surgical intervention. The recommended period of stabilty in different studies varied widely from 4 months to 3 years, but none of these criteria were based on evidence obtained from systematic research.

Not many studies have been conducted analyzing the efficacy of various surgical modalities in vitiligo patches located over treatment refractory areas like acral and bony sites, genital areas,lips, palms and soles. Through this study we shall compare the effectiveness of 3 well established surgical methods - Autologous Mini Punch grafting, Suction blister epidermal grafting and Non cultured epidermal cell suspension on treatment resistant vitiligo lesions present over bony prominences and acral areas( mainly distal areas) with regards to extent of repigmentation, color matching of repigmented area, patient satisfaction and adverse effects if any.