title: Evidence-based management of vitiligo: summary of a Cochrane systematic review.
abstract: Vitiligo affects around 1% of the world's population. Despite it being relatively common, there is still no effective treatment. The objective of this study was to update the Cochrane systematic review of randomized clinical trials (RCTs) to evaluate the efficacy of treatments for vitiligo. We carried out searches of a range of databases to October 2013 for RCTs of interventions for vitiligo regardless of language or publication status. At least two reviewers independently assessed study eligibility and methodological quality and extracted data using data extraction forms approved by the Cochrane Skin Group. Our primary outcomes of interest were quality of life, > 75% repigmentation and adverse effects. We retrieved 96 studies, of which 39 were new studies, with an overall total of 4512 participants. Repigmentation was assessed in all studies, although only five reported on all three of our primary outcomes. Regarding our two secondary outcomes, six studies measured cessation of spread but none assessed long-term permanence of repigmentation at 2 years' follow-up. Most of the studies evaluated combination treatments, which generally showed better repigmentation than monotherapies. Of the new studies, seven were surgical interventions. The majority of the studies had fewer than 50 participants. The quality of the studies was poor to moderate at best. Very few studies specifically included children or participants with segmental vitiligo. Five years after the last update of this review, there are still important variations in study design and outcome measures in clinical trials for vitiligo, limiting the evidence for the efficacy of different therapeutic options. The best evidence from individual trials showed short-term benefit from topical corticosteroids and various forms of ultraviolet radiation combined with topical preparations. Long-term follow-up and patient-rated outcomes should be incorporated into study design, and more studies should assess psychological interventions.
authors.affiliation: Cochrane Skin Group, University of Nottingham, Nottingham, U.K.
authors.forename: M
authors.initials: M
authors.lastname: Whitton
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.|Hospital del Mar Research Institute (IMIM), Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.|Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pinart
authors.affiliation: Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K.
authors.forename: J M
authors.initials: JM
authors.lastname: Batchelor
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, U.K.
authors.forename: J
authors.initials: J
authors.lastname: Leonardi-Bee
authors.affiliation: Unit of Dermatology, CLÍNICA GO&FER, Barcelona, Spain.
authors.forename: U
authors.initials: U
authors.lastname: Gonzalez
authors.affiliation: Department of Dermatology, St George's Hospital, London, U.K.
authors.forename: Z
authors.initials: Z
authors.lastname: Jiyad
authors.affiliation: Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K.
authors.forename: V
authors.initials: V
authors.lastname: Eleftheriadou
authors.affiliation: Department of Dermatology, AP-HP, Hôpital Henri Mondor, Créteil, France.|EA EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), UPEC, Créteil, France.|Université Paris-Est Créteil, Créteil, France.
authors.forename: K
authors.initials: K
authors.lastname: Ezzedine
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects; D062109:Dermatologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D011701:PUVA Therapy / Q000009:adverse effects / Q000379:methods; D011613:Psychotherapy / Q000379:methods; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014820:Vitiligo / Q000628:therapy*
chemical_list: D003879:Dermatologic Agents