During the development of this guideline it was apparent that more research effort needs to be put into the scientific investigation of the causes of vitiligo. Anyone reading the guideline will be struck by the paucity of effective treatments available and the lack of treatments specifically introduced for vitiligo itself. Almost all treatments have been borrowed from therapies whose prime target is another disease. Not even the greater understanding of the science underlying vitiligo, e.g. evidence of autoimmune disease or of oxidative stress in melanocytes, has resulted yet in a treatment specifically tailored towards vitiligo. The interrogation of the available studies and clinical trials did throw up some questions pertinent to the currently available treatments and research recommendations based on these are detailed below.
A longitudinal epidemiological study is needed to define the natural history of vitiligo. This should use photographs combined with computerized image analysis, to quantify how the vitiligo changes with time.
More research is needed on more appropriate QoL tools in vitiligo and they should always be used as outcome measures on studies in vitiligo.
Further research is needed to establish simple, meaningful and reproducible methods of monitoring accurately the response of vitiligo to treatment both in the clinic and in clinical trials.
Further research is needed to clarify the roles of tacrolimus and pimecrolimus in adults and children with vitiligo. A head-to-head study of tacrolimus vs. pimecrolimus is suggested.
In view of the possible long-term risk of skin cancer with extended courses of NB-UVB or PUVA in patients with vitiligo, further research to define this potential risk is recommended.
The British Journal of Dermatology. 2008;159(5):1051-1076. © 2008 Blackwell Publishing
Cite this: Guideline for the Diagnosis and Management of Vitiligo - Medscape - Nov 01, 2008.