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

In All Patients With Vitiligo, What is the Efficacy of Cognitive Therapy vs. Psychological Support or no Treatment in Terms of Condition Progression, Area Reduction and Quality of Life Score?

Cognitive behavioural techniques (CBT) may help patients to cope with skin diseases. There is some suggestion that QoL and coping mechanisms improve over time in vitiligo.[123] Cognitive strategies rather than avoidance or concealment may be associated with better coping.[124] This suggests that cognitive behavioural strategies are potentially helpful (level of evidence 3).

Two papers were identified which addressed the question.[2,125] The first study was small, with only seven patients in each treatment arm.[2] The intervention was not purely CBT but involved training in practical coping strategies with general psychological support. This intervention cannot be blinded and this introduces potential bias. The second study was an RCT of 45 patients randomized into three arms: one received group CBT, one group received person-centred therapy and the other group were controls.[125] Whereas the first study used individual therapy the second one used group therapy which did not allow for the individual assessment of participants. This study did not show that group CBT was effective in improving the condition or improving QoL score.

The first study compared before, after, and a nontreatment arm.[2] The CBT intervention arm showed a sustained improvement in QoL, self-esteem and body image. The effects reported were statistically and clinically significant with patients 'coming into the normal range'. Given the methodological limitations it did not offer sound evidence of the benefit of CBT but it did offer some support for the intervention used. Patients' own cognitive strategies may help coping over time. CBT may offer benefit to patients with vitiligo. Only one study has looked at this directly and it was small in size.[2] Parents of children affected by vitiligo are often very concerned.

Despite the small evidence base on CBT the GDG feels that psychological support and strategies to cope with the psychological effects of disfigurement are an important part of the treatment of vitiligo. This is reflected in the views expressed by the members of the Vitiligo Society. The value of the support given by patient organizations should not be underestimated. Patients should be given information about the Vitiligo Society as part of the management of the disorder. Parents of children with vitiligo may require psychological counselling.

  1. Psychological interventions should be offered as a way of improving coping mechanisms in patients with vitiligo. Parents of affected children should be offered psychological counselling.

    Grade of recommendation D
    Level of evidence 4

Footnote: The organization 'Changing Faces' (The Squire Centre, 33-37 University Street, London WC1E 6JN, U.K.: http://www.changingfaces.org.uk) can give practical help and support to patients and their families. They advise that adjustment is not related to extent of disfigurement but is helped by quality social support, realistic information about treatment options and effective coping strategies, especially on how to manage social anxiety.

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