Current and emerging therapy for the management of vitiligo

Figures & data

Table 1 Conclusions on treatment for vitiligo

	Conclusion	Remarks
Non-surgical treatments
Topical corticosteroids	Effective for the treatment of localized vitiligo	Result of meta-analysis
Oral corticosteroids	Have an adjunct value, not very effective by themselves	No placebo controlled studies have been performed for oral corticosteroids as a monotherapy
(P)UVA	Broadband UVA alone may have a therapeutic value PUVA therapy is as effective as broadband UVB, but with more side-effects	UVA is not studied in RCTs
Broadband UVB	Effective for the treatment for generalized vitiligo
Narrowband UVB	As effective as broadband UVB, and sometimes even preferred over broadband UVB. Preferred for generalized vitiligo	Result of meta-analysis
Excimer laser	Excimer laser is an effective and safe treatment for vitiligo and gives the best results if used on the face
Calcipotriol	Contradicting results: some authors describe a benefit but others do not	No placebo controlled studies have been performed for topical calcipotriol as a monotherapy
Topical immunomodulators	As effective in repigmentation as topical corticosteroids	The effect is mainly restricted to the face and neck
Pseudocatalase cream	May have an effect	Few studies performed Few (comparative) studies performed
Surgical treatments
Autologous minipunchgrafting	Success rates of 40%–99% (mean success rate: 57%) Only a small surface can be treated	Lower mean success rate than epidermal suction blister grafting and split-thickness skin grafting
Epidermal suction blister grafting	Success rates of 73%–88% (mean success rate: 81%)	Only a small surface can be treated
Split-thickness skin grafting	Success rates of 78%–90%
Transplantation of non-cultured epidermal cellsuspension	Success rates of 59%–70% (mean success rate: 63%) Suitable for larger areas
Transplantation of in vitro-cultured epidermis	Success rates of 33%–54%
Transplantation of in vitro-cultured melanocytes	Success rates of 22%–72%
Depigmentation therapy
Monobenzylether of hydroquinone	Effective as a depigmentation therapy	Few studies performed
Mequinol	Effective as a depigmentation therapy	Few studies performed
Complementary therapies
L-phenylalanine	May be used as adjuvant to phototherapy	Few studies performed
Ginkgo biloba	May be effective as monotherapy	Only shown in one study
Polypodium leucomotos	Can improve narrowband UVB-induced repigmentation	Few studies performed
Antioxidants	Can improve the clinical effectiveness of narrowband UVB	Few studies performed

Abbreviations: PUVA, psoralen ultraviolet-A therapy; RCT, randomized controlled trial.