Guidelines for the management of vitiligo

Vitiligo is an acquired disorder of depigmentation affecting 0.1%-2% of the world's population without discrimination of race, age and gender. The disease is characterized by white patches, often symmetrically distributed, which usually increase in size with time, corresponding to a considerable loss of functioning epidermal and sometimes hair follicle melanocyte. There are many treatment options available for the disease. Standardized guidelines for treating this disease in Asian skin are not readily available which leads to no set criteria for treating this cosmetically disfiguring problem. These guidelines have been prepared for dermatologists considering all the latest evidence based data available. Vitiligo is diagnosed clinically, although in some cases biopsy is required. Lesions on face and neck respond well to the treatment. However, segmental and acral types respond poorly to treatment. In the assessment of patient before starting therapy it is important to consider age, pre-existing diseases, in particular autoimmune disorders and previous medications. Topical corticosteroids and/or topical immunomodulators for localized vitiligo and phototherapy for generalized vitiligo are considered as first line therapies. As the treatment often extends over a long period of time, patients are frequently frustrated by the failure of previous treatments, so psychological stress is common and thus psychotherapy has also positive role. These comprehensive guidelines for the diagnosis and management of vitiligo in coloured skin aims to give high quality clinical advice, based on the best available evidence and expert consensus

Efficacy of 0.1% topical tacrolimus with narrow band ultraviolet B phototherapy versus narrow band ultraviolet B phototherapy in vitiligo

To determine the efficacy of combined treatment with narrowband ultraviolet B phototherapy [NB-UVB] and topical tacrolimus in comparison with NB-UVB alone with placebo control in the treatment of vitiligo affecting face and neck. We included 60 patients with vitiligo affecting face and neck with or without involvement of the rest of body, in this randomized, double-blind, placebo-controlled trial. The patients were randomly allocated in two groups as A and B. Topical 0.1% tacrolimus ointment was given for vitiligo patches twice daily in group A, while placebo ointment was given to be applied in similar way for vitiligo patches in group B. Tri-weekly NB-UVB for depigmented areas with starting dose of 0.1J/cm2 with increment of 10% at every visit was given to the patients in both groups. Percentage of depigmented patches was calculated at the baseline, 1, 2 and 3 months. All patients completed the treatment period of 3 months. The mean response at the end of the 3rd month revealed excellent response [>75% repigmentation] in 16 [53.3%] patients in group A and 9 [30%] patients in group B. Good response [50-75% repigmentation] was seen in 11 [36.7%] in group A and 12 [40%] patients in group B. Moderate response [25-49% repigmentation] was shown by 3 [10%] patients in group A and 5 [16.7%] patients in group B. None of the patient showed poor response [<25% repigmentation] in group A, however 4 [13.3%] patients showed poor response in group B. Comparison of efficacy in both groups show excellent and efficacious response in 16 [53.5%] of patients in group A and in only 9 [30%] of patients in group B [P <0.05]. Combined treatment with NB-UVB and topical 0.1% tacrolimus ointment in comparison with NB-UVB with placebo control in the treatment of vitiligo affecting face and neck is more effective