To identify people with vitiligo (including children) who have a greater likelihood of developing autoimmune thyroid disease, screen for antithyroid antibodies and thyroid function.
The quality of life and psychological distress level related to living with vitiligo should be assessed and monitored. Tools for such assessment include the Patient Health Questionnaire-4 (PHQ-4), the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD7) and the Dermatology Life Quality Index (DLQI), and the Vitiligo Impact Patient scale (VIPs) or the vitiligo-specific quality-of-life instrument (VitiQoL).
As first-line primary or secondary care treatment, people with vitiligo should be offered a potent or very potent topical corticosteroid once daily, to minimize potential side effects, with avoidance of the periocular area.
As an alternative to potent or very potent topical corticosteroids in people with facial vitiligo, topical tacrolimus 0.1% ointment twice daily should be considered.
When extensive vitiligo on visible sites is having a negative psychological effect, depigmentation therapies should be considered. However, adequate psychological assessment and/or intervention should first be performed.
To arrest the activity of rapidly progressive vitiligo, the use of oral betamethasone should be considered (after the risks and benefits have been carefully weighed), with the drug administered at 0.1 mg/kg twice weekly on 2 consecutive days for 3 months. The dose should then be tapered by 1 mg per month for an additional 3 months. Treatment should be carried out in combination with narrowband ultraviolet B (NB-UVB) therapy.
Owing to the malignancy risk, people with vitiligo should not receive azathioprine in combination with psoralen–ultraviolet A (PUVA) or NB-UVB.
In people with vitiligo in whom the response to topical therapy has been inadequate and/or in whom extensive or progressive disease exists, whole-body or localized NB-UVB should be offered as first-line phototherapy. The risk-benefit ratio should be discussed, especially for children, since patients generally require a prolonged course. For localized disease sites, the treatment may be used in combination with a topical calcineurin inhibitor (the evidence being greater for tacrolimus) or a potent topical corticosteroid. Patients should be counseled that upon treatment cessation, there is a significant risk of response loss.
When stable, segmental or nonsegmental vitiligo does not respond to other treatments, leaving the patient distressed, cellular grafting, such as blister grafting or cell suspension, should be considered.
For people with vitiligo who are suffering from moderate to severe psychological distress, referral should be offered to psychological services for group and/or individual cognitive behavioral therapy.
For more information, please go to Vitiligo.
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Cite this: Vitiligo Clinical Practice Guidelines (BAD, 2021) - Medscape - Jan 31, 2022.