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Treatment of vitiligo: advantages and disadvantages, indications for use and outcomes.
G Ital Dermatol Venereol. 2011 Oct; 146(5):373-95.GI

Abstract

Topical coticosteroids perform better than placebo and topical PUVAsol in repigmenting vitiliginous skin. Topical corticosteroids compare in efficacy to topical calcineurin inhibitors, but produce greater adverse events. Calcineurin inhibitors are more effective in twice daily dosing and may be used on facial areas and in children. Vitamin D analogues are not as effective as topical corticosteroids as monotherapy, but can increase effectiveness of topical steroids in combination therapy. There are no randomized trials examining pseudocatalase monotherapy. With the advent of NB-UVB, oral PUVA is less used in the treatment of generalized vitiligo. Topical PUVA may be effectively used for the treatment of localized vitiligo. NB-UVB has less side effects and can be used in children. Excimer is also as effective as NB-UVB and may be used in the treatment of localized vitiligo. NB-UVB and excimer combination therapies show some greater effectiveness in repigmentation in vitiligo. All patient undergoing surgical repigmentation therapies, including split-thickness skin grafting, autologous epidermal non-cultured grafts, suction blistering and punch grafting require careful patient selection. Those that have localized, stable vitiligo refractory to other treatments are good surgical candidates. Split thickness skin grafting has the best cosmetic results, with the least side effects. However, scarring of donor and recipient sites is common to split thickness skin grafting. Depigmenting treatments include MBEH, 4-MP, and the Q-switched ruby laser. MBEH and 4-MP may have similar efficacy, but MBEH has a greater side effect profile than 4-MP. Also, visible depigmentation occurs sooner with MBEH as compared with 4-MP, despite both of them requiring long treatment periods. Relapse with both treatments may occur. The Q-switched ruby laser does seem to have the advantage of inducing depigmentation more quickly, but with more discomfort.

Authors+Show Affiliations

Howard University College of Medicine, Washington, DC, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21956273

Citation

Hossani-Madani, A, and R Halder. "Treatment of Vitiligo: Advantages and Disadvantages, Indications for Use and Outcomes." Giornale Italiano Di Dermatologia E Venereologia : Organo Ufficiale, Societa Italiana Di Dermatologia E Sifilografia, vol. 146, no. 5, 2011, pp. 373-95.
Hossani-Madani A, Halder R. Treatment of vitiligo: advantages and disadvantages, indications for use and outcomes. G Ital Dermatol Venereol. 2011;146(5):373-95.
Hossani-Madani, A., & Halder, R. (2011). Treatment of vitiligo: advantages and disadvantages, indications for use and outcomes. Giornale Italiano Di Dermatologia E Venereologia : Organo Ufficiale, Societa Italiana Di Dermatologia E Sifilografia, 146(5), 373-95.
Hossani-Madani A, Halder R. Treatment of Vitiligo: Advantages and Disadvantages, Indications for Use and Outcomes. G Ital Dermatol Venereol. 2011;146(5):373-95. PubMed PMID: 21956273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of vitiligo: advantages and disadvantages, indications for use and outcomes. AU - Hossani-Madani,A, AU - Halder,R, PY - 2011/9/30/entrez PY - 2011/10/1/pubmed PY - 2012/4/4/medline SP - 373 EP - 95 JF - Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia JO - G Ital Dermatol Venereol VL - 146 IS - 5 N2 - Topical coticosteroids perform better than placebo and topical PUVAsol in repigmenting vitiliginous skin. Topical corticosteroids compare in efficacy to topical calcineurin inhibitors, but produce greater adverse events. Calcineurin inhibitors are more effective in twice daily dosing and may be used on facial areas and in children. Vitamin D analogues are not as effective as topical corticosteroids as monotherapy, but can increase effectiveness of topical steroids in combination therapy. There are no randomized trials examining pseudocatalase monotherapy. With the advent of NB-UVB, oral PUVA is less used in the treatment of generalized vitiligo. Topical PUVA may be effectively used for the treatment of localized vitiligo. NB-UVB has less side effects and can be used in children. Excimer is also as effective as NB-UVB and may be used in the treatment of localized vitiligo. NB-UVB and excimer combination therapies show some greater effectiveness in repigmentation in vitiligo. All patient undergoing surgical repigmentation therapies, including split-thickness skin grafting, autologous epidermal non-cultured grafts, suction blistering and punch grafting require careful patient selection. Those that have localized, stable vitiligo refractory to other treatments are good surgical candidates. Split thickness skin grafting has the best cosmetic results, with the least side effects. However, scarring of donor and recipient sites is common to split thickness skin grafting. Depigmenting treatments include MBEH, 4-MP, and the Q-switched ruby laser. MBEH and 4-MP may have similar efficacy, but MBEH has a greater side effect profile than 4-MP. Also, visible depigmentation occurs sooner with MBEH as compared with 4-MP, despite both of them requiring long treatment periods. Relapse with both treatments may occur. The Q-switched ruby laser does seem to have the advantage of inducing depigmentation more quickly, but with more discomfort. SN - 0392-0488 UR - https://www.unboundmedicine.com/medline/citation/21956273/Treatment_of_vitiligo:_advantages_and_disadvantages_indications_for_use_and_outcomes_ L2 - http://www.minervamedica.it/index2.t?show=R23Y2011N05A0373 DB - PRIME DP - Unbound Medicine ER -
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