Vitiligo pp 345-351 | Cite as

Management Overview

  • Alain TaïebEmail author
  • Mauro Picardo


Vitiligo psychosocial impact is essential when considering management issues, as well as previous messages given to the patient. Patients should be informed that (1) vitiligo is a chronic/relapsing disorder, (2) repigmentation is a slow process, and (3) reactivation of the disease in different body regions or the reappearance of lesions in treated ones may occur, which gives a rationale for a maintenance treatment. Initial assessment should focus on overall severity and course of disease profile, with special attention to possible aggravating environmental factors and associated autoimmune diseases, in particular thyroid disease. The first target of therapy is in most cases to stop disease progression of the disease, best achieved by combined approaches phototherapy, systemic and local drug intervention. Narrowband UVB is the most useful repigmenting regimen, with the current development of home phototherapy devices. Potent topical corticosteroid or topical calcineurin inhibitor therapy may be used first line for localized disease; on the face, calcineurin inhibitors are currently preferred because of potential side effects of prolonged application of steroids and their good safety profile. In addition to psychological support, offering training to camouflage techniques is particularly helpful in dark-skinned patients for facial/hand lesions. Cellular transplantation or grafting is an option in specialized centers for patients who have stable and limited lesions that are refractory to other therapy. Depigmenting techniques are difficult to handle and concern a minority of patients.


  1. 1.
    Taïeb A, Picardo M, VETF Members. The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. Pigment Cell Res. 2007;20:27–35.Google Scholar
  2. 2.
    Diallo A, Boniface K, Jouary T, Seneschal J, Morice-Picard F, Prey S, Cario-André M, Mazereeuw-Hautier J, Taieb A, Ezzedine K. Development and validation of the K-VSCOR for scoring Koebner’s phenomenon in vitiligo/non-segmental vitiligo. Pigment Cell Melanoma Res. 2013;26:402–7.PubMedGoogle Scholar
  3. 3.
    Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CC, Goh BK, Anbar T, Silva de Castro C, Lee AY, Parsad D, van Geel N, Le Poole IC, Oiso N, Benzekri L, Spritz R, Gauthier Y, Hann SK, Picardo M, Taieb A, Vitiligo Global Issue Consensus Conference Panelists. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2012;25:E1–13.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Kostopoulou P, Jouary T, Quintard B, Marques S, Boutchnei S, et al. Objective vs subjective factors in the psychological impact of vitiligo: the experience from a French referral center. Br J Dermatol. 2009;161(1):128–33.PubMedGoogle Scholar
  5. 5.
    Salzes C, Abadie S, Seneschal J, Whitton M, Meurant JM, Jouary T, Ballanger F, Boralevi F, Taieb A, Taieb C, Ezzedine K, The Vitiligo Impact Patient Scale (VIPs). Development and validation of a vitiligo burden assessment tool. J Invest Dermatol. 2016;136:52–8.PubMedGoogle Scholar
  6. 6.
    Gey A, Diallo A, Seneschal J, Léauté-Labrèze C, Boralevi F, Jouary T, Taieb A, Ezzedine K. Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms. Br J Dermatol. 2013;168:756–61.PubMedGoogle Scholar
  7. 7.
    Betterle C, Caretto A, De Zio A, et al. Incidence and significance of organ-specific autoimmune disorders (clinical, latent or only autoantibodies) in patients with vitiligo. Dermatologica. 1985;171:419–23.PubMedGoogle Scholar
  8. 8.
    Gan EY, Eleftheriadou V, Esmat S, Hamzavi I, Passeron T, Böhm M, Anbar T, Goh BK, Lan C-CE, Lui H, Ramam M, Raboobee N, Katayama I, Suzuki T, Parsad D, Seth V, Lim H, van Geel N, Mulekar S, Harris J, Wittal R, Benzekri L, Gauthier Y, Kumarasinghe P, Thng STG, de Castro CCS, Abdallah M, Vrijman C, Bekkenk M, Seneschal J, Pandya A, Ezzedine K, Picardo M, Taïeb A, on behalf of the VGICC. Repigmentation in vitiligo: position paper of the Vitiligo Global Issues Consensus Conference (VGICC). Pigment Cell Melanoma Res. 2017;30(1):28–40.PubMedGoogle Scholar
  9. 9.
    Radakovic-Fijan S, Fürnsinn-Friedl AM, Hönigsmann H, et al. Oral dexamethasone pulse treatment for vitiligo. J Am Acad Dermatol. 2001;44:814–7.PubMedGoogle Scholar
  10. 10.
    Rajatanavin N, Suwanachote S, Kulkollakarn S. Dihydroxyacetone: a safe camouflaging option in vitiligo. Int J Dermatol. 2008;47:402–6.PubMedGoogle Scholar
  11. 11.
    Rivard J, Hexsel C, Owen M, Strickland FM, et al. Photoadaptation of vitiliginous skin to targeted ultraviolet B phototherapy. Photodermatol Photoimmunol Photomed. 2007;23:258–60.PubMedGoogle Scholar
  12. 12.
    Seiter S, Ugurel S, Tilgen W, et al. Use of high-dose methylprednisolone pulse therapy in patients with progressive and stable vitiligo. Int J Dermatol. 2000;39:624–7.PubMedGoogle Scholar
  13. 13.
    Cavalié M, Ezzedine K, Fontas E, Montaudié H, Castela E, Bahadoran P, Taïeb A, Lacour JP, Passeron T. Maintenance therapy of adult vitiligo with 0.1% tacrolimus ointment: a randomized, double blind, placebo-controlled study. J Invest Dermatol. 2015;135:970–4.PubMedGoogle Scholar
  14. 14.
    Westerhof W, Nieuweboer-Krobotova L. Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. Arch Dermatol. 1997;133:1525–8.PubMedGoogle Scholar
  15. 15.
    Anbar TS, Westerhof W, Abdel-Rahman AT, et al. Evaluation of the effects of NB-UVB in both segmental and non-segmental vitiligo affecting different body sites. Photodermatol Photoimmunol Photomed. 2006;20(22):157–63.Google Scholar
  16. 16.
    Eleftheriadou V, Thomas K, Ravenscroft J, Whitton M, Batchelor J, Williams H. Feasibility, double-blind, randomised, placebo-controlled, multi-centre trial of hand-held NB-UVB phototherapy for the treatment of vitiligo at home (HI-Light trial: Home Intervention of Light therapy). Trials. 2014;15:51.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Yones SS, Palmer RA, Garibaldinos TM, et al. Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UV-A therapy vs Narrowband-UV-B therapy. Arch Dermatol. 2007;143:578–84.PubMedGoogle Scholar
  18. 18.
    Casacci M, Thomas P, Pacifico A, et al. Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo--a multicentre controlled study. J Eur Acad Dermatol Venereol. 2007;2:956–63.Google Scholar
  19. 19.
    Chiavérini C, Passeron T, Ortonne JP. Treatment of vitiligo by topical calcipotriol. J Eur Acad Dermatol Venereol. 2002;16:137–8.PubMedGoogle Scholar
  20. 20.
    Dell’Anna ML, Mastrofrancesco A, Sala R, et al. Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol. 2007;32:631–6.PubMedGoogle Scholar
  21. 21.
    Falabella R. Treatment of localized vitiligo by autologous minigrafting. Arch Dermatol. 1988;124:1649–55.PubMedGoogle Scholar
  22. 22.
    Forschner T, Buchholtz S, Stockfleth E. Current state of vitiligo therapy--evidence-based analysis of the literature. J Dtsch Dermatol Ges. 2007;5:467–75.PubMedGoogle Scholar
  23. 23.
    Gauthier Y, Surleve-Bazeille JE. Autologous grafting with noncultured melanocytes: a simplified method for treatment of depigmented lesions. J Am Acad Dermatol. 1992;26(2 Pt 1):191–4.PubMedGoogle Scholar
  24. 24.
    Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008;159:1051–76.PubMedGoogle Scholar
  25. 25.
    Lan CC, Chen GS, Chiou MH, et al. FK506 promotes melanocyte and melanoblast growth and creates a favourable milieu for cell migration via keratinocytes: possible mechanisms of how tacrolimus ointment induces repigmentation in patients with vitiligo. Br J Dermatol. 2005;153:498–505.PubMedGoogle Scholar
  26. 26.
    Lan C, Wu C, Chen G, et al. Helium-neon laser and topical tacrolimus combination therapy: novel treatment option for vitiligo without additional photocarcinogenic risks. J Eur Acad Dermatol Venereol. 2009;23(3):344–5.PubMedGoogle Scholar
  27. 27.
    Lim HW, Hexsel CL. Vitiligo: to treat or not to treat. Arch Dermatol. 2007;143:643–6.PubMedGoogle Scholar
  28. 28.
    Mehrabi D, Pandya AG. A randomized, placebo-controlled, double-blind trial comparing narrowband UV-B plus 0.1% tacrolimus ointment with narrowband UV-B plus placebo in the treatment of generalized vitiligo. Arch Dermatol. 2006;142:927–9.PubMedGoogle Scholar
  29. 29.
    Middelkamp-Hup MA, Bos JD, Rius-Diaz F, et al. Treatment of vitiligo vulgaris with narrow-band UVB and oral Polypodium leucotomos extract: a randomized double-blind placebo-controlled study. J Eur Acad Dermatol Venereol. 2007;21:942–50.PubMedGoogle Scholar
  30. 30.
    Njoo MD, Vodegel RM, Westerhof W. Depigmentation therapy in vitiligo universalis with topical 4-methoxyphenol and the Q-switched ruby laser. J Am Acad Dermatol. 2000;42(5 Pt 1):760–9.PubMedGoogle Scholar
  31. 31.
    Olsson MJ, Juhlin L. Epidermal sheet grafts for repigmentation of vitiligo and piebaldism, with a review of surgical techniques. Acta Derm Venereol. 1997;77:463–6.PubMedGoogle Scholar
  32. 32.
    Parsad D, Gupta S, IADVL Dermatosurgery Task Force. Standard guidelines of care for vitiligo surgery. Indian J Dermatol Venereol Leprol. 2008;74(Suppl):S37–45.PubMedGoogle Scholar
  33. 33.
    Parsad D, Pandhi R, Dogra S, et al. Clinical study of repigmentation patterns with different treatment modalities and their correlation with speed and stability of repigmentation in 352 vitiliginous patches. J Am Acad Dermatol. 2004;50:63–7.PubMedGoogle Scholar
  34. 34.
    Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo. Clin Exp Dermatol. 2003;28:285–7.PubMedGoogle Scholar
  35. 35.
    Passeron T, Ostovari N, Zakaria W, et al. Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo. Arch Dermatol. 2004;140:1065–9.PubMedGoogle Scholar
  36. 36.
    Yu HS, Wu CS, Yu CL, et al. Helium-neon laser irradiation stimulates migration and proliferation in melanocytes and induces repigmentation in segmental-type vitiligo. J Invest Dermatol. 2003;120:56–64.PubMedGoogle Scholar
  37. 37.
    Westerhof W, Nieuweboer-Krobotova L, Mulder PG, et al. Left-right comparison study of the combination of fluticasone propionate and UV-A vs. either fluticasone propionate or UV-A alone for the long-term treatment of vitiligo. Arch Dermatol. 1999;135:1061–6.PubMedGoogle Scholar
  38. 38.
    Luger T, Boguniewicz M, Carr W, Cork M, Deleuran M, Eichenfield L, Eigenmann P, Fölster-Holst R, Gelmetti C, Gollnick H, Hamelmann E, Hebert AA, Muraro A, Oranje AP, Paller AS, Paul C, Puig L, Ring J, Siegfried E, Spergel JM, Stingl G, Taieb A, Torrelo A, Werfel T, Wahn U. Pimecrolimus in atopic dermatitis: consensus on safety and the need to allow use in infants. Pediatr Allergy Immunol. 2015;26:306–15.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Rustin MH. The safety of tacrolimus ointment for the treatment of atopic dermatitis: a review. Br J Dermatol. 2007;157:861–73.PubMedGoogle Scholar
  40. 40.
    Taieb A, Alomar A, Böhm M, Dell’Anna ML, De Pase A, Eleftheriadou V, Ezzedine K, Gauthier Y, Gawkrodger DJ, Jouary T, Leone G, Moretti S, Nieuweboer-Krobotova L, Olsson MJ, Parsad D, Passeron T, Tanew A, van der Veen W, van Geel N, Whitton M, Wolkerstorfer A, Picardo M, Vitiligo European Task Force (VETF); European Academy of Dermatology and Venereology (EADV); Union Europeénne des Médecins Spécialistes (UEMS). Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2013;168:5–19.PubMedGoogle Scholar
  41. 41.
    Sassi F, Cazzaniga S, Tessari G, Chatenoud L, Reseghetti A, Marchesi L, Girolomoni G, Naldi L. Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. Br J Dermatol. 2008;159:1186–91.PubMedGoogle Scholar
  42. 42.
    Van Geel N, Ongenae K, De Mil M. Double-blind placebo-controlled study of autologous transplanted epidermal cell suspensions for repigmenting vitiligo. Arch Dermatol. 2004;140:1203–8.PubMedGoogle Scholar
  43. 43.
    Szczurko O, Boon HS. A systematic review of natural health product treatment for vitiligo. BMC Dermatol. 2008;8(1):2.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Caron-Schreinemachers AL, Kingswijk MM, Bos JD, et al. UVB 311 nm tolerance of vitiligo skin increases with skin phototype. Acta Derm Venereol. 2005;85(1):24–6.PubMedGoogle Scholar
  45. 45.
    Anbar TS, Hegazy RA, Picardo M, Taieb A. Beyond vitiligo guidelines: combined stratified/personalized approaches for the vitiligo patient. Exp Dermatol. 2014;23(4):219–23. Review.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Hôpital Saint-André Service de DermatologieBordeauxFrance
  2. 2.Cutaneous Physiopathology and CIRMSan Gallicano Dermatological Institute, IRCCSRomeItaly

Personalised recommendations