Current state of vitiligo therapy--evidence-based analysis of the literature.
Vitiligo is a skin disease with a worldwide prevalence ranging from 0.5% to 4%. Conservative therapies include photochemotherapy, phototherapy with UVB radiation (broadband UVB 290-320 nm, narrow band UVB 311 nm), systemic steroids and pseudocatalase. Modern therapeutic options include treatment with topical immunomodulators (tacrolimus, pimecrolimus), analogues of vitamin D3, excimer laser and surgery/transplantation. Our analysis compares these therapies for vitiligo and the evidence levels supporting their effectiveness.


CONCLUSIONS
The face and neck respond best to all therapeutic approaches, while the acral areas are least responsive. For generalized vitiligo, phototherapy with UVB radiation is most effective with the fewest side effects; PUVA is the second best choice.Topical corticosteroids are the preferred drugs for localized vitiligo. They may be replaced by topical immunomodulators which display comparable effectiveness and fewer side effects. The effectiveness of vitamin D analogues is controversial with limited data. Surgical therapy can be very successful, but requires an experienced surgeon and is very demanding of time and facilities, thus limiting its widespread use. L-phenylalanine therapy appears effective on the face but enjoys neither widespread use nor extensive data support. No single therapy for vitiligo can be regarded as the most effective as the success of each treatment modality depends on the type and location of vitiligo.
Forschner
Tobias
T
Department of Dermatology, Venereology and Allergy, Charité Universitätsmedizin Berlin, Germany. tobias.forschner@charite.de
Buchholtz
Stefan
S
Stockfleth
Eggert
E
D002762:Cholecalciferol / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D053685:Laser Therapy / Q000706:statistics & numerical data*; D010506:Periodicals as Topic / Q000706:statistics & numerical data; D010789:Phototherapy / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D014820:Vitiligo / Q000453:epidemiology* / Q000628:therapy*
D007155:Immunologic Factors; D013256:Steroids; D002762:Cholecalciferol