title: Interventions for vitiligo.
abstract: BACKGROUND
  Around one per cent of the world's population has vitiligo, a disease which causes white patches on the skin. There are a variety of treatments available, most of which are unsatisfactory.
  
  
  OBJECTIVE
  To assess all interventions used to manage vitiligo.
  
  
  METHODS
  In November 2009 we updated searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 4, 2009), MEDLINE, EMBASE, AMED, PsycINFO, LILACS and ongoing trials databases.
  
  
  METHODS
  Randomised controlled trials (RCTs).
  
  
  METHODS
  At least 2 review authors independently assessed study eligibility and methodological quality, and carried out data extraction. Two of the 57 included studies could be combined for meta-analysis.
  
  
  RESULTS
  In this update, 57 trials, including 19 from the original review, were assessed with 3139 participants. Most of the RCTs, which covered a wide range of interventions, had fewer than 50 participants. All of the studies assessed repigmentation, 6 measured cessation of spread, and 5 investigated the effect of treatment on quality of life.Most of the studies assessed combination therapies which generally reported better results. New interventions include monochromatic excimer light (MEL), Polypodium leucotomos, melanocyte transplantation, oral antioxidants, Chinese zengse pill, and pimecrolimus. We analysed the data from 28 studies that met our outcome criteria of improvement in quality of life and greater than 75% repigmentation.Fifteen analyses from studies comparing various interventions showed a statistically significant difference between the proportions of participants achieving more than 75% repigmentation. The majority of analyses showing statistically significant differences were from studies that assessed combination interventions which generally included some form of light treatment.Topical preparations, in particular corticosteroids, reported most adverse effects. However, in the combination studies it was difficult to ascertain which treatment caused these effects. None of the studies was able to demonstrate long-term benefits. Very few studies were conducted on children or included segmental vitiligo. We found one study of psychological interventions and none evaluating micropigmentation, depigmentation, or cosmetic camouflage.
  
  
  CONCLUSIONS
  This review has found some evidence from individual studies to support existing therapies for vitiligo, but the usefulness of the findings is limited by the different designs and outcome measurements and lack of quality of life measures. There is a need for follow-up studies to assess permanence of repigmentation as well as high quality randomised trials using standardised measures and which also address quality of life.
authors.affiliation: c/o Cochrane Skin Group, The University of Nottingham, Room A103, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR.
authors.forename: Maxine E
authors.initials: ME
authors.lastname: Whitton
authors.forename: Mariona
authors.initials: M
authors.lastname: Pinart
authors.forename: Jonathan
authors.initials: J
authors.lastname: Batchelor
authors.forename: Clare
authors.initials: C
authors.lastname: Lushey
authors.forename: Jo
authors.initials: J
authors.lastname: Leonardi-Bee
authors.forename: Urbà
authors.initials: U
authors.lastname: González
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D011701:PUVA Therapy / Q000379:methods; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013256:Steroids / Q000008:administration & dosage; D014820:Vitiligo / Q000628:therapy*
chemical_list: D013256:Steroids