Guideline for the diagnosis and management of vitiligo

Abstract

Summary This detailed and user‐friendly guideline for the diagnosis and management of vitiligo in children and adults aims to give high quality clinical advice, based on the best available evidence and expert consensus, taking into account patient choice and clinical expertise. The guideline was devised by a structured process and is intended for use by dermatologists and as a resource for interested parties including patients. Recommendations and levels of evidence have been graded according to the method developed by the Scottish Inter‐Collegiate Guidelines Network. Where evidence was lacking, research recommendations were made. The types of vitiligo, process of diagnosis in primary and secondary care, and investigation of vitiligo were assessed. Treatments considered include offering no treatment other than camouflage cosmetics and sunscreens, the use of topical potent or highly potent corticosteroids, of vitamin D analogues, and of topical calcineurin inhibitors, and depigmentation with p‐(benzyloxy)phenol. The use of systemic treatment, e.g. corticosteroids, ciclosporin and other immunosuppressive agents was analyzed. Phototherapy was considered, including narrowband ultraviolet B (UVB), psoralen with ultraviolet A (UVA), and khellin with UVA or UVB, along with combinations of topical preparations and various forms of UV. Surgical treatments that were assessed include full‐thickness and split skin grafting, mini (punch) grafts, autologous epidermal cell suspensions, and autologous skin equivalents. The effectiveness of cognitive therapy and psychological treatments was considered. Therapeutic algorithms using grades of recommendation and levels of evidence have been produced for children and for adults with vitiligo.

Role of oxidative stress in the pathogenesis of vitiligo with special emphasis on the antioxidant action of narrowband ultraviolet B phototherapy

“…4,8 In this context, NB-UVB phototherapy is recommended in preference to oral PUVA because of evidence of greater efficacy and safety, as well as because of the substantial repigmentation rates that are achieved, particularly on the face, trunk and proximal extremities. 1,4,[24][25][26] In this regard, a lower likelihood of erythema and xerosis development, carcinogenic effects and a lack of oral treatment obligation were reported advantages of NB-UVB phototherapy when compared with PUVA.…”

“…6,7 This indicated that a wavelength of around 311 nm had a favourable safety profile and was clinically more effective than full-spectrum UVB. Since then, NB-UVB phototherapy has been used as a first-choice strategy for most vitiligo patients, 8 as an alternative to the mainstay of treatment for generalized and focal vitiligo, which utilizes psoralen plus UVA (PUVA) photochemotherapy and topical corticosteroids (such an approach has been used for many years). 9 Narrowband-UVB has been reported to be a good wavelength to which vitiligo responds.…”

Multicenter study of the efficacy of combination therapy of patients with vitiligo (narrowband phototherapy in combination with Vitiskin local antioxidant)

“…В последние годы одним из патогенетических методов лечения считают применение местных ан-тиоксидантов и УФ-В-терапию (UVB TL01) с дли-ной волны 311 нм [4,7,8]. Разработан гель Вити-скин, который содержит супероксиддисмутазу, спо-собствующую нейтрализации свободных радикалов, благодаря чему стимулируется общий метаболизм в клетках [4,7].…”

“…Разработан гель Вити-скин, который содержит супероксиддисмутазу, спо-собствующую нейтрализации свободных радикалов, благодаря чему стимулируется общий метаболизм в клетках [4,7]. Витискин относится к гидрогелям, действующим на всех уровнях регулирования депиг-ментации.…”

Vitiligo y terapia con inmunoglobulina intravenosa: a propósito de un paciente con síndrome de Sjögren

“…actualmente, disponemos de diversas aproximaciones terapéuticas para esta patología, las que dependen principalmente de la extensión del compromiso cutáneo y del tipo de piel, sin embargo, no existe hasta el momento un tratamiento completamente efectivo 3 .…”