Guidelines for the management of vitiligo

Afsheen Bilal, Irfan Anwar

Abstract


Vitiligo is an acquired disorder of depigmentation affecting 0.1%-2% of the world’s population without discrimination of race, age and gender. The disease is characterized by white patches, often symmetrically distributed, which usually increase in size with time, corresponding to a considerable loss of functioning epidermal and sometimes hair follicle melanocyte. There are many treatment options available for the disease. Standardized guidelines for treating this disease in Asian skin are not readily available which leads to no set criteria for treating this cosmetically disfiguring problem. These guidelines have been prepared for dermatologists considering all the latest evidence based data available. Vitiligo is diagnosed clinically, although in some cases biopsy is required. Lesions on face and neck respond well to the treatment. However, segmental and acral types respond poorly to treatment. In the assessment of patient before starting therapy it is important to consider age, pre-existing diseases, in particular autoimmune disorders and previous medications. Topical corticosteroids and/or topical immunomodulators for localized vitiligo and phototherapy for generalized vitiligo are considered as first line therapies. As the treatment often extends over a long period of time, patients are frequently frustrated by the failure of previous treatments, so psychological stress is common and thus psychotherapy has also positive role. These comprehensive guidelines for the diagnosis and management of vitiligo in coloured skin aims to give high quality clinical advice, based on the best available evidence and expert consensus.

 


Keywords


Vitiligo ,guidelines, management

Full Text:

PDF

References


Fai D, Cassano N, Vena GA. Narrow-band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients. J Eur Acad Dermatol Venereol. 2007;21:916-20.

Nicolaidou E, Antoniou C, Stratigos A, Katsambas AD. Narrowband ultraviolet B phototherapy and 308-nm excimer laser in the treatment vitiligo: A review. J Am Acad Dermatol. 2009;60:470-7.

Majid I. Vitiligo Management: An Update. Br J Med Practit. 2010;3:1-6.

Mattoo SK, Handa S, Kaur I et al. Psychiatric morbidity in vitiligo: prevalence and correlates in India. J Eur Acad Dermatol Venereol. 2002;16:573-8.

Aghaei S, Sodaifi M, Jafri P et al. DLQI scores in vitiligo: reliability and validity of the Persian version. BMC Dermatol. 2004;**4-8.

Habib A, Sheikh ZI, Khan Q, Rahman SB. Efficacy and safety of oral dexamethasone pulse treatment for vitiligo. Pak Armed Forces Med J. 2006;56: 111-5.

Lotti T, Buggiani G, Troiano M et al. Targeted and combination treatment for vitiligo. Comparative evaluation of different current modalities in 458 subjects. Dermatol Ther. 2008;21:S20-6.

Taieb A, Picardo M. Clinical practice. Vitiligo. N Engl J Med. 2009;360:160-9.

Le Poole IC, Das PK, van den Wijngaard RM et al. Review of the etiopathomechanism of vitiligo: a convergence theory. Exp Dermatol. 1993;2:145-53.

Hann SK, Lee HJ. Segmental vitiligo: clinical findings in 208 patients. J Am Acad Dermatol. 1996;35:671-4.

Kitamura R, Tsukamoto K, Harada K et al. Mechanisms underlying the dysfunction of melanocytes in vitiligo epidermis: role of SCF/KIT protein interactions and the downstream effector, MITF-M. J Pathol. 2004;202:463-75.

Le Poole IC, van den Wijngaard RM, Westerhof W, Das PK. Tenascin is overexpressed in vitiligo lesional skin and inhibits melanocyte adhesion. Br J Dermatol. 1997;137:171-8.

Shajil EM, Chatterjee S, Agrawal D et al. Vitiligo: pathomechanisms and genetic polymorphism of susceptible genes. Indian J Exp Biol. 2006;44:526-39.

Nordlund JJ, Lerner AB. Vitiligo. It is important. Arch Dermatol. 1982;118:5-8.

Gawkrodger DJ, Ormerod AD, Shaw L et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008;159:1051-76.

Halder RM, Taliaferro SJ. Vitiligo. In: Wolff K, Goldsmith L, Katz S et al., editors. Fitzpatrick’s Dermatology in General Medicine. New York: McGraw-Hill; 2008. p. 616-22.

Arycan O, Koc K, Ersoy L. Clinical characteristics in 113 Turkish vitiligo patients. Acta Dermatovenerol Alp Panonica Adriat. 2008;17:129-32.

Hann SK, Lee HJ. Segmental vitiligo: clinical findings in 208 patients. J Am Acad Dermatol. 1996;35:671-4.

Barona MI, Arrunategui A, Falabella R, Alzate A. An epidemiologic case-control study in a population with vitiligo. J Am Acad Dermatol. 1995;33:621-5.

Mazereeuw-Hautier J, Bezio S, Mahe E et al. Segmental and nonsegmental childhood vitiligo has distinct clinical characteristics: a prospective observational study. J Am Acad Dermatol. 2010;62:945-9.

Chun WH, Hann SK. The progression of nonsegmental vitiligo: clinical analysis of 318 patients. Int J Dermatol. 1997;36:908-10.

Ortonne J-P, Passeron T. Vitiligo and other disorders of hypopigmentation. In: Bolognia J, Jorizzo J, Rapini R, editors. Dermatology, 3rd edn. Philadelphia: Mosby Elsevier; 2012. p. 1023-48.

Hann SK, Kim YS, Yoo JH, Chun YS. Clinical and histopathologic characteristics of trichrome vitiligo. J Am Acad Dermatol. 2000;42:589-96.

Pagovich OE, Silverberg JI, Freilich E, Silverberg NB. Thyroid abnormalities in pediatric patients with vitiligo in New York City. Cutis. 2008;81:463-6.

Iacovelli P, Sinagra JL, Vidolin AP et al. Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo. Dermatology. 2005;210:26-30.

Kakourou T, Kanaka-Gantenbein C, Papadopoulou A et al. Increased prevalence of chronic autoimmune (Hashimoto’s) thyroiditis in children and adolescents with vitiligo. J Am Acad Dermatol. 2005;53:220-3.

Dittmar M, Kahaly GJ. Polyglandular autoimmune syndromes: immunogenetics and long-term follow-up. J Clin Endocrinol Metab. 2003;88:2983-92.

Powell FC, Dicken CH. Psoriasis and vitiligo. Acta Derm Venereol. 1983;63:246-9.

Hong CK, Lee MH, Jeong KH et al. Clinical analysis of hearing levels in vitiligo patients. Eur J Dermatol. 2009;19:50-6.

Gopal KV, Rama Rao GR, Kumar YH et al. Vitiligo: a part of a systemic autoimmune process. Indian J Dermatol Venereol Leprol. 2007;73:162-5.

Flynn GE. Bilateral uveitis, poliosis, and vitiligo; with a hereditary factor. Am J Ophthalmol. 1952;35:568-72.

Tsuruta D, Hamada T, Teramae H et al. Inflammatory vitiligo in Vogt-Koyanagi-Harada disease. J Am Acad Dermatol. 2001;44:129-31.

Wong SS, Ng SK, Lee HM. Vogt-Koyanagi-Harada disease: extensive vitiligo with prodromal generalized erythroderma. Dermatology. 1999;198:65-8.

Barnes L. Vitiligo and the Vogt-Koyanagi-Harada syndrome. Dermatol Clin. 1988;6:229-39.

Sukavatcharin S, Tsai JH, Rao NA. Vogt-Koyanagi-Harada disease in Hispanic patients. Int Ophthalmol. 2007;27:143-8.

Tesavibul N, Sansanayuth W. Vogt-Koyanagi-Harada disease in Thai patients. J Med Assoc Thai. 2005;88(suppl 9):S26-30.

Rathinam SR, Vijayalakshmi P, Namperumalsamy P et al. Vogt-Koyanagi-Harada syndrome in children. Ocul Immunol Inflamm. 1998;6:155-61.

Boutimzine N, Laghmari A, Ouazzani I et al. Vogt-Koyanagi-Harada syndrome. Epidemiological, clinical and disease progression aspects. Twenty cases [in French]. J Fr Ophthalmol. 1998;21:746-5.

Ardigo M, Malizewsky I, Dell’anna ML et al. Preliminary evaluation of vitiligo using in vivo reflectance confocal microscopy. J Eur Acad Dermatol Venereol. 2007;21:1344-50.

Taiebi A, Alomar A, Bohm M et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2013;168:5-9.

Kandil E. Treatment of vitiligo with 0-1 per cent betamethasone 17-valerate in isopropyl alcohol—a double-blind trial. Br J Dermatol. 1974;91:457-60.

Westerhof W, Nieuweboer-Krobotova L, Mulder PG, Glazenburg EJ. Left-right comparison study of the combination of fluticasone propionate and UV-A vs. either fluticasone propionate or UV-A alone for the long-term treatment of vitiligo. Arch Dermatol. 1999;135:1061-6.

Grimes PE, Morris R, Avaniss-Aghajani E et al. Topical tacrolimus therapy for vitiligo: therapeutic responses and skin messenger RNA expression of proinflammatory cytokines. J Am Acad Dermatol. 2004;51:52-61.

Kwinter J, Pelletier J, Khambalia A, Pope E. High-potency steroid use in children with vitiligo: a retrospective study. J Am Acad Dermatol. 2007;56:236-41.

Lepe V, Moncada B, Castanedo-Cazares JP et al. A double-blind randomized trial of 0.1% tacrolimus vs 0.05% clobetasol for the treatment of childhood vitiligo. Arch Dermatol. 2003;139:581-5.

Kandil E. Treatment of vitiligo with 0-1 per cent betamethasone 17-valerate in isopropyl alcohol—a double-blind trial. Br J Dermatol. 1974;91:457-60.

Radakovic-Fijan S, Furnsinn-Friedl AM, Honigsmann H, Tanew A. Oral dexamethasone pulse treatment for vitiligo. J Am Acad Dermatol. 2001;44:814-7.

Kim SM, Lee HS, Hann SK. The efficacy of low-dose oral corticosteroids in the treatment of vitiligo patients. Int J Dermatol. 1999;38:546-50.

Rath N, Kar HK, Sabhnani S. An open labeled, comparative clinical study on efficacy and tolerability of oral minipulse of steroid (OMP) alone, OMP with PUVA and broad / narrow band UVB phototherapy in progressive vitiligo. Indian J Dermatol Venereol Leprol. 2008;74:357-60.

Castro AP. Calcineurin inhibitors in the treatment of allergic dermatitis. J Pediatr (Rio J). 2006;82(5 suppl):S166-72.

Tanghetti EA. Tacrolimus ointment 0.1% produces repigmentation in patients with vitiligo: results of a prospective patient series. Cutis. 2003;71:158-62.

Mayoral FA, Vega JM, Stavisky H et al. Retrospective analysis of pimecrolimus cream 1% for treatment of facial vitiligo. J Drugs Dermatol. 2007;6:517-21.

Seirafi H, Farnaghi F, Firooz A et al. Pimecrolimus cream in repigmentation of vitiligo. Dermatology. 2007;214:253-9.

De D, Kanwar AJ. Tacrolimus-induced hyperpigmentation in a patch of vitiligo. Skinmed. 2008;7:93-4.

Adorini L, Penna G. Dendritic cell tolerogenicity: a key mechanism in immunomodulation by vitamin D receptor agonists. Hum Immunol. 2009;70:345-52.

Birlea SA, Costin GE, Norris DA. Cellular and molecular mechanisms involved in the action of vitamin D analogs targeting vitiligo depigmentation. Curr Drug Targets. 2008;9:345-59.

Kumaran MS, Kaur I, Kumar B. Effect of topical calcipotriol, betamethasone dipropionate and their combination in the treatment of localized vitiligo. J Eur Acad Dermatol Venereol. 2006;20:269-73.

Arca E, Tastan HB, Erbil AH et al. Narrow-band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo. J Dermatol. 2006;33:338-43.

Hartmann A, Lurz C, Hamm H et al. Narrow-band UVB311 nm vs. broad-band UVB therapy in combination with topical calcipotriol vs. placebo in vitiligo. Int J Dermatol. 2005;44:736-42.

Ada S, Sahin S, Boztepe G et al. No additional effect of topical calcipotriol on narrow-band UVB phototherapy in patients with generalized vitiligo. Photodermatol Photoimmunol Photomed. 2005;21:79-83.

Felsten LM, Alikhan A, Rosic VP. Vitiligo: A comprehensive overview. J Am Acad Dermatol. 2011;65:493-514.

Wu CS, Lan CC, Wang LF et al. Effects of psoralen plus ultraviolet A irradiation on cultured epidermal cells in vitro and patients with vitiligo in vivo. Br J Dermatol. 2007;156:122-9.

El Mofty M, Mostafa W, Esmat S et al. Narrow band ultraviolet B 311 nm in the treatment of vitiligo: two right-left comparison studies. Photodermatol Photoimmunol Photomed. 2006;22:6-11.

El Mofty M, Zaher H, Esmat S et al. PUVA and PUVB in vitiligo—are they equally effective? Photodermatol Photoimmunol Photomed. 2001;17:159-63.

De Francesco V, Stinco G, Laspina S et al. Immunohistochemical study before and after narrow band (311 nm) UVB treatment in vitiligo. Eur J Dermatol. 2008;18:292-6.

Kanwar AJ, Dogra S. Narrow-band UVB for the treatment of generalized vitiligo in children. Clin Exp Dermatol. 2005;30:332-6.

Ortonne JP, MacDonald DM, Micoud A, Thivolet J. PUVA-induced repigmentation of vitiligo: a histochemical (split-DOPA) and ultrastructural study. Br J Dermatol. 1979;101:1-12.

Kao CH, Yu HS. Comparison of the effect of 8-methoxypsoralen (8-MOP) plus UVA (PUVA) on human melanocytes in vitiligo vulgaris and in vitro. J Invest Dermatol. 1992;98:734-40.

Parsad D, Pandhi R, Dogra S, Kumar B. Clinical study of repigmentation patterns with different treatment modalities and their correlation with speed and stability of repigmentation in 352 vitiliginous patches. J Am Acad Dermatol. 2004;50:63-7.

El-Mofty M, Mostafa W, Youssef R et al. Ultraviolet A in vitiligo. Photodermatol Photoimmunol Photomed. 2006;22:214-6.

Hann SK, Cho MY, Im S, Park YK. Treatment of vitiligo with oral 5-methoxypsoralen. J Dermatol. 1991;18:324-9.

Lassus A, Halme K, Eskelinen A et al. Treatment of vitiligo with oral methoxsalen and UVA. Photodermatol. 1984;1:170-3.

Yones SS, Palmer RA, Garibaldinos TM, Hawk JL. Randomized double-blind trial of treatment of vitiligo: efficacy psoralen UVA therapy versus narrowband UVB therapy. Arch Dermatol. 2007;143:578-84.

Sassi F, Cazzaniga S, Tessari G et al. Randomized controlled trial comparing the effectiveness of 308 nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. Br J Dermatol. 2008;159:1186-91.

Castanedo-Cazares JP, Lepe V, Moncada B. Repigmentation of chronic vitiligo lesions by following tacrolimus plus ultraviolet B narrow band. Photodermatol Photoimmunol Photomed. 2003;19:35-6.

Nordal E, Guleng G, Ro¨nnevig J. Treatment of vitiligo with narrowband-UVB (TL01) combined with tacrolimus ointment (0.1%) vs. placebo ointment, a randomized right ⁄left double blind comparative study. J Eur Acad Dermatol Venereol. 2011;25:1440-3.

Goldinger SM, Dummer R, Schmid P et al. Combination of 308 nm xenon chloride excimer laser and topical calcipotriol in vitiligo. J Eur Acad Dermatol Venereol. 2007;21:504–8.

Van Geel N, Ongenae K, De Mil M et al. Double-blind placebo controlled study of autologous transplanted epidermal cell suspensions for repigmenting vitiligo. Arch Dermatol. 2004;140:1203–8.

Bayoumi W, Fontas E, Silard L et al. Effect of a preceding laser dermabrasion on the outcome of combined therapy with narrowband ultraviolet B and potent topical steroids for treating nonsegmental vitiligo in resistant localizations. Br J Dermatol. 2012;166:208-11.

Shen Z, Gao TW, Chen L et al. Optimal frequency of treatment with the 308-nm excimer laser for vitiligo on the face and neck. Photomed Laser Surg. 2007;25:418-27.

Leone G, Iacovelli P, Paro Vidolin A, Picardo M. Monochromatic excimer light 308 nm in the treatment of vitiligo: a pilot study. J Eur Acad Dermatol Venereol. 2003;17:531-7.

Lan CC, Wu CS, Chiou MH et al. Low-energy helium-neon laser induces locomotion of the immature melanoblasts and promotes melanogenesis of the more differentiated melanoblasts: recapitulation of vitiligo repigmentation in vitro. J Invest Dermatol. 2006;126:2119-26.

Dell’Anna ML, Mastrofrancesco A, Sala R et al. Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol. 2007;32:631-6.

Patel DC, Evans AV, Hawk JL. Topical pseudocatalase mousse and narrowband UVB phototherapy is not effective for vitiligo: an open, single-centre study. Clin Exp Dermatol. 2002;27:641-4.

Tanioka M, Miyachi Y. Camouflaging vitiligo of the fingers. Arch Dermatol. 2008;144:809-10.

Nordlund JJ, Forget B, Kirkwood J, Lerner AB. Dermatitis produced by applications of monobenzone in patients with active vitiligo. Arch Dermatol. 1985;121:1141-4.

Hedges TR 3rd, Kenyon KR, Hanninen LA, Mosher DB. Corneal and conjunctival effects of monobenzone in patients with vitiligo. Arch Ophthalmol. 1983;101:64-8.

Papadopoulos L, Bor R, Legg C. Coping with the disfiguring effects of vitiligo: a preliminary investigation into the effects of cognitive-behavioural therapy. Br J Med Psychol. 1999;72(pt 3):385-96.

Birol A, Kisa U, Kurtipek GS et al. Increased tumor necrosis factor alpha (TNF-alpha) and interleukin 1 alpha (IL1-alpha) levels in the lesional skin of patients with nonsegmental vitiligo. Int J Dermatol. 2006;45:992-3.

Parsad D, Kanwar AJ. Oral minocycline in the treatment of vitiligo—a preliminary study. Dermatol Ther. 2010;23:305-7.

Radmanesh M, Saedi K. The efficacy of combined PUVA and low-dose azathioprine for early and enhanced repigmentation in vitiligo patients. J Dermatolog Treat. 2006;17:151-3.


Refbacks

  • There are currently no refbacks.


ISSN: 1560-9014