Guidelines for the treatment of vitiligo

At present, there is no universally effective drug for vitiligo therapy; there are, however, various therapeutic modalities that may be beneficial. Therapeutic regimens used to treat vitiligo include psoralens and ultraviolet A light (PUVA), topical corticosteroids, fluorouracil locally applied with skin abrasion, a variety of surgical techniques to transplant autologous melanocytes from pigmented skin to nonpigmenting areas, a new photochemotherapeutic regimen using oral khellin with UVA phototherapy, and a recently proposed treatment with oral phenylalanine in combination with UVA exposure. PUVA and topical corticosteroids are the 2 most frequently used modalities. The use of effective sunscreens with a high sun protection factor (SPF) is of help in preventing the vitiliginous areas from burning and normal skin from becoming tanned. Cosmetic camouflage is also useful to disguise the white areas of skin. Finally, depigmentation should be considered in patients with greater than 50% cutaneous involvement who fail to respond or are unwilling to undergo treatment. The selection of patients for therapy should take into consideration the patient's motivation, the psychological impact of the disease and the clinical presentation of vitiligo, and should weigh the risks and benefits of prolonged therapy.