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Which treatments work best for vitiligo?

Summaries of two new Cochrane reviews that could apply to your next consultation

Summaries of two new Cochrane reviews that could apply to your next consultation

A variety of methods for repigmenting the skin of people with vitiligo has been tried in various parts of the world. Around 1 per cent of the world's population has vitiligo. The treatments currently available are largely unsatisfactory and vary widely between cultures and within health systems.

We searched the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials, Medline, EMBASE, AMED and other databases (last searched September 2004). Reference lists of articles and conference proceedings were searched. Authors of reviews were contacted.

Nineteen trials with a total of 1,350 participants were included. The RCTs generally had low numbers of participants and only RCTs of repigmentation and not other methods of managing vitiligo were able to be included.

In one study, potent topical steroids resulted in better repigmentation than placebo and were also better than oral psoralens plus sunlight in another study (RR 4.70 95 per cent CI 1.14 to 19.39) although their long-term use is limited by adverse effects.

Two studies suggested topical calcipotriol enhanced repigmentation rates from PUVAsol and PUVA when compared with placebo. Another two studies showed higher repigmentation rates with oral PUVAsol versus placebo plus sunlight (RR 19.20 95 per cent CI 1.21 to 304.50 in 79 adults and RR 2.29 95 per cent CI 1.14 to 4.58 in a study of 50 children).

The safety of these interventions was poorly described and none of the studies was able to demonstrate long-term benefits. Very few studies were carried out on children or included segmental vitiligo. No trials evaluating micropigmentation, melanocyte transplantation, depigmentation or cosmetic camouflage could be found. Despite the fact that the main impact of vitiligo is psychosocial, only one study on psychological therapy was found and it is awaiting assessment.

Authors' conclusionsThis review has found some evidence to support existing therapies for vitiligo, but the different designs and outcome measurements, lack of quality of life measures and adverse effect reporting in the studies limit the usefulness of their findings. There is a pressing need for high-quality randomised trials using standardised measures of repigmentation and which address relevant clinical outcomes including quality of life.Whitton ME et al. Interventions for vitiligo. The Cochrane Database of Systematic Reviews, 2006, Issue 1

The Cochrane Library (see right) contains high-quality information about the effects of health care from the Cochrane Collaboration, a UK-registered international charity and the world's leading producer of systematic reviews.UK residents are able to access the Cochrane Library free. To gain maximum benefit, ie download PDFs, log on to www.thecochranelibrary.com and click on 'Do you already have access?' to enter via the host site for your particular country.Guest users may access abstracts for all reviews in the database.

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