Therapeutic interventions for vitiligo.

BACKGROUND: Current treatments for vitiligo, a common pigmentary disorder affecting around 1% of the world's population, are largely unsatisfactory.

OBJECTIVE: We sought to report a Cochrane review of all interventions for the treatment of vitiligo.

METHODS: We systematically searched a range of databases for randomized controlled trials. At least two reviewers independently assessed study eligibility, methodological quality, and extracted data.

RESULTS: Nineteen trials were included. We found moderate evidence of the benefit of topical steroids. Our search uncovered limited to moderate evidence for various types and regimens of phototherapy (ultraviolet [UV] A and UVB) used alone or in combination with oral and topical treatments. Topical khellin combined with UVA should be questioned in view of the lack of available evidence of benefit. There is limited evidence of the benefit of topical tacrolimus and topical calcipotriol used in conjunction with UV light, and for oral ginkgo biloba, and thin split-thickness grafts.

LIMITATIONS: Studies generally were poorly designed and reported.

CONCLUSIONS: Variations in study design and different outcome measures limit the evidence for the different therapeutic options. The best evidence from individual trials showed short-term benefit from topical steroids and various forms of UV light with topical preparations. Long-term follow-up and patient-centered outcomes should be incorporated in study design and psychologic interventions need more attention.