Effectiveness of vitiligo therapy in prospective observational study of 250 cases with review of consensus and individualized care perspective

ABSTRACT

Outcomes of six month therapy in 250 patients bearing varying disease profiles and treatment regimens delivered either in conformity or divergence from consensus guidelines were compared. Influence of trait variables of patients and disease on the outcomes was also examined. Consensus approach yielded superior rates of repigmentation and improved quality of life. The latter effect significantly influenced the former. Therapy adhering guidelines did not yield optimal benefit in patients of younger age, with disease of shorter standing and involving resistant sites. Steroids best benefited the localized disease as topical monotherapy. Combination of steroid with photochemotherapy adhering guidelines benefited less in moderate disease extent. Steroid overtreatment in extensive disease compromised the prospects of repigmentation. Localized short duration disease may better be first treated with steroid-alternative immunosuppressants. Wider spread more than 3% body surface may also respond to their combination with steroids, prior applying photochemotherapy. Additive therapies are prudent with steroid/photochemotherapy than injudicious steroid overuse in progressive extensive disease. Strategies to counter steroid unresponsiveness and adverse effects, psychiatric address to stress, nutrient and environmental interventions deserve emphasis