About 1 percent of the world’s population, (50 million people), have vitiligo. Unlike conditions such as psoriasis, eczema and acne, systemic therapy is seldom considered by Dermatologists as a first line treatment for vitiligo. Reasons for this aversion include: the lack of documented guidelines for the introduction of systemic agents, paucity of clinical trials demonstrating efficacy, non-familiarity with available agents, concern about side effects, unclear therapeutic endpoints, and the continued misconception that vitiligo is only a cosmetic problem. The potential consequences of these barriers to systemic treatment, include the continued extension of vitiligo lesions, a submaximal treatment response, an increased relapse rate, and the risk of immeasurable psychosocial consequences such as embarrassment, depression, employment discrimination and relationship problems.
The majority of Dermatologists continue to approach vitiligo with apathy often offering little more than stock-line phrases such as “it can’t be cured, it’s only cosmetic”, “just cover it up” and “let’s try this cream and see what happens”. With increasing research and understanding of vitiligo, comes the need for a change of Dermatologic mindset from a reactive “let’s wait and see what happens” approach to a proactive “let’s take control and make things happen” management strategy.
This presentation reviews current vitiligo pathogenesis and its’ relevance to systemic treatment, the assessment of stability and instability in vitiligo patients, considerations and indications for systemic therapy, a review of currently available systemic agents, and a suggested updated vitiligo treatment algorithm based on current available evidence.