Title:Vitiligo: An Updated Narrative Review
Volume: 17
Issue: 2
Author(s): Alexander K.C. Leung*, Joseph M. Lam, Kin Fon Leong and Kam Lun Hon
Affiliation:
- Department of Pediatrics, The University of Calgary, The Alberta Children’s Hospital, Calgary, Alberta,Canada
Keywords:
Depigmentation, hypopigmentation, topical corticosteroids, topical calcineurin inhibitors, vitiligo, ultraviolet B
phototherapy.
Abstract:
Background: Vitiligo is a relatively common acquired pigmentation disorder that can
cause significant psychological stress and stigmatism.
Objective: This article aims to familiarize physicians with the clinical manifestations, evaluation,
diagnosis, and management of vitiligo.
Methods: A Pubmed search was conducted in Clinical Queries using the key term “vitiligo”. The
search included meta-analyses, randomized controlled trials, clinical trials, observational studies,
and reviews. The search was restricted to English language. The information retrieved from the
above search was used in the compilation of the present article.
Results: Approximately one quarter of patients with vitiligo have the onset before 10 years of age.
Genetic, immunological, neurogenic and environmental factors may have a role to play in the
pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches
that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally
in size with time. Sites of predilection include the face, followed by the neck, lower
limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair
skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics.
If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors,
and narrowband ultraviolet B phototherapy are the mainstays of treatment.
Conclusion: The therapeutic effect of all the treatment modalities varies considerably from individual
to individual. As such, treatment must be individualized. In general, the best treatment response
is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical
corticosteroids and calcineurin inhibitors are the treatment choice for those with localized disease.
Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas,
face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who
have widespread vitiligo or those with localized vitiligo associated with a significant impact on the
quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.
