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Vitiligo: concise evidence based guidelines on diagnosis and management
  1. David J Gawkrodger1,
  2. Anthony D Ormerod2,
  3. Lindsay Shaw3,
  4. Inma Mauri-Sole3,
  5. Maxine E Whitton4,
  6. M Jane Watts5,
  7. Alex V Anstey6,
  8. Jane Ingham7,
  9. Katharine Young7
  1. 1British Association of Dermatologists, London, UK
  2. 2Therapy, Guidelines and Audit subcommittee of the British Association of Dermatologists, London, UK
  3. 3Departments of Dermatology and Paediatric Dermatology, Bristol Royal Infirmary, Bristol, UK
  4. 4The Vitiligo Society, London, UK
  5. 5Department of Dermatology, Whipps Cross Hospital, London, UK
  6. 6British Photodermatology Group, British Association of Dermatologists, UK
  7. 7Clinical Standards Department, Royal College of Physicians of London, London, UK
  1. Correspondence to Professor David J Gawkrodger, Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK; david.gawkrodger{at}sth.nhs.uk

Abstract

Vitiligo is a common disease that causes a great degree of psychological distress. In its classical forms it is easily recognised and diagnosed. This review provides an evidence based outline of the management of vitiligo, particularly with the non-specialist in mind. Treatments for vitiligo are generally unsatisfactory. The initial approach to a patient who is thought to have vitiligo is to make a definite diagnosis, offer psychological support, and suggest supportive treatments such as the use of camouflage cosmetics and sunscreens, or in some cases after discussion the option of no treatment. Active therapies open to the non-specialist, after an explanation of potential side effects, include the topical use of potent or highly potent steroids or calcineurin inhibitors for a defined period of time (usually 2 months), following which an assessment is made to establish whether or not there has been a response. Patients whose condition is difficult to diagnose, unresponsive to straightforward treatments, or is causing psychological distress, are usually referred to a dermatologist. Specialist dermatology units have at their disposal phototherapy, either narrow band ultraviolet B or in some cases photochemotherapy, which is the most effective treatment presently available and can be considered for symmetrical types of vitiligo. Depigmenting treatments and possibly surgical approaches may be appropriate for vitiligo in selected cases. There is no evidence that presently available systemic treatments are helpful and safe in vitiligo. There is a need for further research into the causes of vitiligo, and into discovering better treatments.

  • Vitiligo
  • guideline
  • diagnosis
  • treatment
  • general physician

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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