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Vitiligo treatments

Answer

Vitiligo is a chronic skin condition that can be managed through a variety of therapeutic approaches. These include topical therapies, systemic therapies, phototherapy, and in rare cases, depigmentation therapy.

Topical therapies

Systemic therapies

  • Corticosteroids: Systemic corticosteroids, such as dexamethasone, prednisone, or methylprednisolone, are recommended for patients with acute, rapidly progressing vitiligo. The DDG 2022 guidelines suggest administering these corticosteroids on 2 consecutive days per week for a duration of 3-6 months to achieve disease arrest . The BAD 2022 guidelines also recommend offering oral betamethasone 0.1 mg/kg twice weekly on 2 consecutive days for 3 months followed by tapering the dose by 1 mg/month for a further 3 months in combination with narrowband UVB in patients with rapidly progressive vitiligo

Phototherapy

  • Narrowband UVB: The DDG 2022 guidelines recommend offering narrowband UVB to patients with generalized vitiligo if topical therapy is no longer feasible due to the extent of disease, and to patients with active, progressive vitiligo to arrest disease activity . They also suggest considering a combination of narrowband UVB with topical corticosteroids or calcineurin inhibitors to enhance the effect of narrowband UVB, particularly in the face and neck region
  • Targeted phototherapy: The DDG 2022 guidelines suggest combining targeted phototherapy with topical and systemic medications (such as corticosteroids, topical calcineurin inhibitors) to enhance the effect

Depigmentation therapy

  • Depigmentation therapy is considered only in extremely rare cases after all other therapeutic options have been exhausted. It is used very restrictively and only after a thorough discussion with the patient due to the irreversible destruction of melanocytes

In conclusion, the treatment of vitiligo involves a combination of topical and systemic therapies, phototherapy, and in rare cases, depigmentation therapy. The choice of treatment depends on the extent and progression of the disease, the patient's response to treatment, and the potential side effects of the therapies.

References

1

Vitiligo

Medical management

Guidelines

Topical therapies, corticosteroids

Pathway
BAD 2022