Guidelines for the Management of Vitiligo

The European Dermatology Forum Consensus

A. Taieb; A. Alomar; M. Böhm; M.L. Dell'Anna; A. De Pase; V. Eleftheriadou; K. Ezzedine; Y. Gauthier; D.J. Gawkrodger; T. Jouary; G. Leone; S. Moretti; L. Nieuweboer-Krobotova; M.J. Olsson; D. Parsad; T. Passeron; A. Tanew; W. van der Veen; N. van Geel; M. Whitton; A. Wolkerstorfer; M. Picardo

Disclosures

The British Journal of Dermatology. 2013;168(1):5-19. 

In This Article

Topical Corticosteroids

Topical corticosteroids (TCS) have been applied since the 1950s for their anti-inflammatory and immunomodulating effects. As first-line treatment for limited forms of vitiligo TCS and topical calcineurin inhibitors (TCI) are now widely used.[7]

Efficacy

Topical corticosteroids have the best results (75% of repigmentation) on sun-exposed areas (face and neck),[8,9] in dark skin[10] and in recent lesions.[11] Acral lesions respond poorly. In a meta-analysis of nonsurgical therapies for vitiligo, modest, but significant effectiveness was shown with a success rate of 33% (16/48) vs. 0% (0/48) in the placebo groups.[8] No differences in efficacy were found between clobetasol and tacrolimus,[12] and between clobetasol[13] or mometasone[14] and pimecrolimus, although TCI might be less effective for extrafacial lesions. When used in the short term, TCS appear to be safe and effective treatment for both children and adults.[7]

Local side-effects (skin atrophy, telangiectasia, hypertrichosis, acneiform eruptions and striae) of potent or very potent TCS are well known. Lower potency classes of TCS and newer class III TCS, such as mometasone furoate and methylprednisolone aceponate, are largely devoid of these side-effects.

Currently, there are no studies available on optimal duration of TCS therapy and on discontinuous applications that could improve the therapeutic index.[7]

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