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Vitiligo

Key sources
The following summarized guidelines for the evaluation and management of vitiligo are prepared by our editorial team based on guidelines from the British Association of Dermatologists (BAD 2022) and the German Society of Dermatology (DDG 2022).
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Guidelines

1.Diagnostic investigations

Initial assessment: elicit a full history in patients with vitiligo including the site and type of vitiligo (segmental, nonsegmental), disease extent (affected BSA), disease stability, speed of onset, trigger factors, QoL, psychological and psychosocial impact, and personal and family history of associated thyroid dysfunction or other autoimmune disease.
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  • Screening for thyroid disease

  • Screening for vitamin D deficiency

  • Assessment of psychosocial impact

2.Medical management

Topical therapies, corticosteroids, BAD: offer a potent or very potent topical corticosteroid once daily, to minimize potential side-effects and avoiding the periocular area, as first-line therapy in primary or secondary care in patients with vitiligo.
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  • Topical therapies (calcineurin inhibitors)

  • Topical therapies (vitamin D analogs)

  • Systemic therapies (corticosteroids)

  • Systemic therapies (other agents)

  • Depigmentation therapy

3.Nonpharmacologic interventions

Sun protection: as per BAD 2022 guidelines, advise using sunscreen with 4-star or 5-star UVA rating and sun protection factor 50 in patients with vitiligo, applied to affected patches and surrounding skin before going outdoors into the sun.
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  • Cosmetic camouflage

  • Psychological support

  • Complementary therapies

4.Therapeutic procedures

Ultraviolet phototherapy: as per BAD 2022 guidelines, offer narrowband UVB (whole body or localized, such as home-based handheld) as first-line phototherapy in patients with vitiligo exhibiting inadequate response to topical therapy and/or having extensive or progressive disease.
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  • Targeted phototherapy

  • CO2 laser therapy

5.Surgical interventions

Tissue grafting
As per BAD 2022 guidelines:
Consider offering cellular grafting, for example blister grafting or cell suspension, in patients with stable, segmental or nonsegmental vitiligo unresponsive to other treatments, and in patients remaining distressed by the condition.
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Insufficient evidence to recommend mini-punch grafting in patients with vitiligo.
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6.Patient education

Patient education
Provide patients with vitiligo (including pediatric patients) with a patient information leaflet on the condition and prescribed treatments.
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Provide information on self-help (such as leaflets, books, websites, apps) in patients with vitiligo with mild psychological distress.
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7.Follow-up and surveillance

Indications for referral: refer patients with suspected vitiligo to a healthcare professional experienced in managing the condition (secondary care specialist or general physicians with enhanced role) if there is diagnostic uncertainty, or the condition condition is progressing rapidly, has a significant psychosocial impact or does not respond to topical treatment.
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More topics in this section

  • Assessment of treatment response