Guideline for the Diagnosis and Management of Vitiligo

D.J. Gawkrodger; A.D. Ormerod; L. Shaw; I. Mauri-Sole; M.E. Whitton; M.J. Watts; A.V. Anstey; J. Ingham; K. Young

Disclosures

The British Journal of Dermatology. 2008;159(5):1051-1076. 

In This Article

Introduction

Vitiligo is a disease process that results in depigmented areas in the skin. It usually begins after birth and, although it can develop in childhood, the average age at onset is about 20years.[1] Most commonly, vitiligo produces symmetrical depigmented areas of skin that otherwise appears normal. A less common type is the segmental form in which asymmetrical, one-sided depigmentation develops.

An important aspect of vitiligo is the psychological effect of the disease. Vitiligo is often immediately visible to others and those with the condition may suffer social and emotional consequences including low self-esteem, social anxiety, depression, stigmatization and, in extreme cases, rejection by those around them.[2] In people with a pale white skin colour, vitiligo may cause little concern.

There is increasing evidence to support the view that vitiligo is an autoimmune disease and that it shows a familial trait in about 18% of cases.[3] The diagnosis of vitiligo is in many cases regarded as being straightforward, although this is not always the case. However, the treatment of vitiligo is acknowledged as being difficult. Hence, an evidence-based review of the management of the disease is timely.

Method of Guideline Development

The development of this guideline was a combined effort involving the Therapy Guidelines and Audit Subcommittee of the British Association of Dermatologists, the Clinical Standards Department of the Royal College of Physicians of London, The Cochrane Skin Group, and the Vitiligo Society. The Guideline Development Group (GDG) included one trainee dermatologist who is also a paediatrician (L.S.), one general practitioner with an interest in dermatology (I.M.-S.), one nurse (M.J.W.), one patient representative of the Vitiligo Society who is also a member of The Cochrane Skin Group (M.E.W.), and three dermatologists (A.V.A., A.D.O. and D.J.G.). Technical and methodological support was provided by the Royal College of Physicians Clinical Standards Department (J.I., K.Y. and Karen Reid), and administrative support by the British Association of Dermatologists. The Cochrane Skin Group has already published a systematic review of interventions for vitiligo.[4]

Aims

The objective of the process was to produce a detailed and user-friendly guideline giving the best available clinical advice for the management of vitiligo, based on the best available evidence and expert consensus, taking into account patient choice and clinical expertise. The guideline is intended for use by dermatologists (with an abbreviated version available for other healthcare professionals) and as a resource for interested parties including patients.

Scope

Diagnosis and management for adults and children with any type of vitiligo were considered. Other depigmenting diseases were considered in the differential diagnosis but their further management was not included.

Audience

The audience for this guideline is healthcare professionals, including doctors, nurses, psychologists, and indeed patients themselves and their carers. Commissioning organizations and health service providers may also find the guideline helpful.

Process

Nine meetings were held over a period of 12months. A systematic approach was taken to the development of the guideline, using the method developed by the Scottish Inter-Collegiate Guidelines Network (SIGN; http://www.sign.ac.uk/methodology/index.html). In the initial meetings, the questions to be answered were formulated. Subsequently, literature searches were performed to obtain the evidence, which was subsequently appraised. This appraisal was performed in a standardized way according to the method described by SIGN (see Table 1 and Table 2 ).

Tables showing the results were produced and are available on the website (http://www.bad.org.uk). The evidence was discussed at meetings of the group where the level of the evidence and the grade of the recommendations were agreed. Where no evidence was available, consensus statements were drawn up. Lastly, the entire guideline was agreed by the GDG.

Funding, Declaration of Interests and Review

The expenses for the meetings of the GDG were underwritten by the British Association of Dermatologists. The Royal College of Physicians of London bore the costs of the work done by the members from the Clinical Standards Department. The members of the Group were not paid for their work.

The guideline will be reviewed in 5 years time.

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