title: Vitiligo: concise evidence based guidelines on diagnosis and management.
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.
authors: British Association of Dermatologists, London, UK. david.gawkrodger@sth.nhs.uk
authors: David J
authors: DJ
authors: Gawkrodger
authors: Anthony D
authors: AD
authors: Ormerod
authors: Lindsay
authors: L
authors: Shaw
authors: Inma
authors: I
authors: Mauri-Sole
authors: Maxine E
authors: ME
authors: Whitton
authors: M Jane
authors: MJ
authors: Watts
authors: Alex V
authors: AV
authors: Anstey
authors: Jane
authors: J
authors: Ingham
authors: Katharine
authors: K
authors: Young
mesh_terms: D065095:Calcineurin Inhibitors; D019317:Evidence-Based Medicine / Q000379:methods; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D010789:Phototherapy / Q000379:methods; D017410:Practice Guidelines as Topic; D014820:Vitiligo / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D065095:Calcineurin Inhibitors; D005938:Glucocorticoids