Stabilizing Progressive Vitiligo with Systemic Treatment: Identifying Factors Associated With Patients Requiring...

Patients with active vitiligo are treated with systemic immunosuppressants to halt disease progression. However, clinical features associated with patients whose condition is more difficult to control are unknown.

This study aimed to identify the clinical features of patients requiring extended periods of systemic immunosuppressants and the real-world clinical course of active vitiligo patients receiving systemic treatments.

This was a single-center retrospective study. Records of actively progressing vitiligo patients from September 2017 to August 2023 were reviewed.

One hundred and fifty-nine patients with non-segmental actively progressing vitiligo were enrolled. In the six-month follow-up period, 101 (63.52%) patients required oral systemic immunosuppressants for ≤ 16 weeks without reactivation (Group 1), 51 (32.08%) patients required continuous systemic immunosuppressants for more than 16 weeks to achieve disease stabilization (Group 2), and seven (4.4%) patients achieved disease stabilization ≤16 weeks of oral immunosuppressants but recurred within nine months after stabilization (Group 3). Patients in Group 2 were significantly younger (39.69±11.51 vs. 46.47±14.91 years old; P=0.013) and had a lower proportion of facial involvement (56.86% vs. 76.24%; P=0.016) compared to Group 1. Similarly, both age (odds ratio (OR): 0.968; P=0.016) and facial involvement (OR: 0.432; P=0.023) were identified as significant factors associated with decreased risk for Group 2. At one-year follow-up, 10.89% of Group 1 patients experienced disease reactivation.

Older patients and patients with facial involvement were more likely to achieve disease stabilization. Careful photo documentation is essential to optimal vitiligo management as disease reactivation is common after systemic treatment, even if initial disease stabilization is achieved.