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Vitiligo pp 345-351 | Cite as

Management Overview

  • Alain TaïebEmail author
  • Mauro Picardo
Chapter

Abstract

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.

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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

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