Vitiligo: Unmet Need, Management and Treatment Guidelines

Overview

Journal Dermatol Pract Concept

Specialty Dermatology

Date 2024 Jan 19

PMID 38241398

Authors

Angelo Valerio Marzano

Silvia Alberti-Violetti

Carlo Alberto Maronese

Gianluca Avallone

Claudio Jommi

Affiliations

Soon will be listed here.

Abstract

Vitiligo is a chronic depigmenting disorder characterized by characteristic, non-scaly, chalky-white skin macules and patches, due to the loss of skin pigment. Its exact pathogenesis is still not fully understood but it seems to be an autoimmune disease where the combination of genetic, environmental, and immune factors contributes to the destruction of melanocytes in the epidermis. Vitiligo is classified into different types based on its clinical characteristics and distribution patterns. The two main forms of vitiligo are non-segmental vitiligo (NSV) and segmental vitiligo (SV). NSV is the predominant form, characterized by symmetrical skin patches, that tend to evolve over time. In contrast, SV has unilateral or band-shaped lesions that progress rapidly but often stabilize early. Herein, current unmet needs in terms of psychosocial consequences and relative lack of valid therapeutic approaches are critically analyzed and put in perspective in the Italian prescribing scenario. Finally, available management guidelines are illustrated and briefly compared, to provide context for upcoming treatment options.

References

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

Wang G, Qiu D, Yang H, Liu W . The prevalence and odds of depression in patients with vitiligo: a meta-analysis. J Eur Acad Dermatol Venereol. 2017; 32(8):1343-1351. DOI: 10.1111/jdv.14739. View

Finlay A, Khan G . Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994; 19(3):210-6. DOI: 10.1111/j.1365-2230.1994.tb01167.x. View

Njoo M, Spuls P, Bos J, Westerhof W, Bossuyt P . Nonsurgical repigmentation therapies in vitiligo. Meta-analysis of the literature. Arch Dermatol. 1999; 134(12):1532-40. DOI: 10.1001/archderm.134.12.1532. View

Picardo M, Huggins R, Jones H, Marino R, Ogunsola M, Seneschal J . The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes. J Eur Acad Dermatol Venereol. 2022; 36(9):1507-1523. PMC: 9790455. DOI: 10.1111/jdv.18129. View

Rosmarin D, Passeron T, Pandya A, Grimes P, Harris J, Desai S . Two Phase 3, Randomized, Controlled Trials of Ruxolitinib Cream for Vitiligo. N Engl J Med. 2022; 387(16):1445-1455. DOI: 10.1056/NEJMoa2118828. View

Bohm M, Schunter J, Fritz K, Salavastru C, Dargatz S, Augustin M . S1 Guideline: Diagnosis and therapy of vitiligo. J Dtsch Dermatol Ges. 2022; 20(3):365-378. DOI: 10.1111/ddg.14713. View

Tavoletti G, Avallone G, Conforti C, Roccuzzo G, Maronese C, Mattioli M . Topical ruxolitinib: A new treatment for vitiligo. J Eur Acad Dermatol Venereol. 2023; 37(11):2222-2230. DOI: 10.1111/jdv.19162. View

Rodrigues M, Ezzedine K, Hamzavi I, Pandya A, Harris J . New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol. 2017; 77(1):1-13. DOI: 10.1016/j.jaad.2016.10.048. View

10.

Taieb A, Alomar A, Bohm M, Dellanna M, De Pase A, Eleftheriadou V . Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2012; 168(1):5-19. DOI: 10.1111/j.1365-2133.2012.11197.x. View

11.

Kroenke K, Spitzer R, Williams J . The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-13. PMC: 1495268. DOI: 10.1046/j.1525-1497.2001.016009606.x. View

12.

Ezzedine K, Eleftheriadou V, Whitton M, van Geel N . Vitiligo. Lancet. 2015; 386(9988):74-84. DOI: 10.1016/S0140-6736(14)60763-7. View

13.

Seneschal J, Speeckaert R, Taieb A, Wolkerstorfer A, Passeron T, Pandya A . Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the international Vitiligo Task Force-Part 2: Specific treatment recommendations. J Eur Acad Dermatol Venereol. 2023; 37(11):2185-2195. DOI: 10.1111/jdv.19450. View

14.

Jommi C, Meregaglia M, Pinto C . . Glob Reg Health Technol Assess. 2023; 10:70-78. PMC: 10551671. DOI: 10.33393/grhta.2023.2624. View

15.

Kruger C, Schallreuter K . Stigmatisation, Avoidance Behaviour and Difficulties in Coping are Common Among Adult Patients with Vitiligo. Acta Derm Venereol. 2014; 95(5):553-8. DOI: 10.2340/00015555-1981. View

16.

Eleftheriadou V, Atkar R, Batchelor J, McDonald B, Novakovic L, Patel J . British Association of Dermatologists guidelines for the management of people with vitiligo 2021. Br J Dermatol. 2021; 186(1):18-29. DOI: 10.1111/bjd.20596. View

17.

Salzes C, Abadie S, Seneschal J, Whitton M, Meurant J, Jouary T . The Vitiligo Impact Patient Scale (VIPs): Development and Validation of a Vitiligo Burden Assessment Tool. J Invest Dermatol. 2016; 136(1):52-8. DOI: 10.1038/JID.2015.398. View

18.

van Geel N, Speeckaert R, Taieb A, Ezzedine K, Lim H, Pandya A . Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm. J Eur Acad Dermatol Venereol. 2023; 37(11):2173-2184. DOI: 10.1111/jdv.19451. View

19.

Vrijman C, Kroon M, Limpens J, Leeflang M, Luiten R, van der Veen J . The prevalence of thyroid disease in patients with vitiligo: a systematic review. Br J Dermatol. 2012; 167(6):1224-35. DOI: 10.1111/j.1365-2133.2012.11198.x. View

20.

Kruger C, Panske A, Schallreuter K . Disease-related behavioral patterns and experiences affect quality of life in children and adolescents with vitiligo. Int J Dermatol. 2013; 53(1):43-50. DOI: 10.1111/j.1365-4632.2012.05656.x. View