Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The extent and distribution of vitiligo often changes during the course of a person's lifetime and its progression is unpredictable.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of medical treatments, and of ultraviolet light treatments, for vitiligo in children and in adults? We searched: Medline, Embase, The Cochrane Library and other important databases up to March 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 25 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids, oral levamisole, topical immunomodulators, topical Vitamin D analogues, ultraviolet A plus psoralen (PUVA), and ultraviolet B (narrowband, and broadband).
Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, caused by the loss of functioning melanocytes.
Vitiligo patches can appear anywhere on the skin, but common sites are usually around the orifices, the genitals, or sun-exposed areas such as the face and hands.The extent and distribution of vitiligo often changes during the course of a person's lifetime, and its progression is unpredictable.
Limited courses of potent topical corticosteroids are a safe and effective therapy for localised vitiligo and are often the first-choice treatment for this.
The consensus is that adverse effects of oral corticosteroids outweigh the benefits in vitiligo. There is currently insufficient evidence available to assess their effectiveness.
Narrowband UVB is considered a safe and effective therapy for moderate to severe generalised vitiligo and is often the first-choice treatment for this.
Tacrolimus requires further evaluation, but is well tolerated in children and adults without the long-term adverse effects of topical corticosteroids.
There is currently insufficient evidence available to assess other immunomodulators in vitiligo.
Vitiligo patches in certain body areas, such as the acral sites, palms and soles, lips, mucosa, and nipples, and segmental forms in any area are relatively resistant to all conventional treatment modalities.
In these cases, counselling and cosmetic camouflage become a priority, and often no treatments are advocated.
There is insufficient evidence to assess topical vitamin D analogues,
levamisole, and broadband UVB in vitiligo.
Consensus is that for the treatment of vitiligo in adults, oral PUVA is effective, whereas topical PUVA is unlikely to be effective. However, topical PUVA has fewer adverse effects than oral PUVA. PUVA is likely to be harmful in children.