Consensus on the treatment of vitiligo – Brazilian Society of Dermatology

Abstract

Background Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.

Expression patterns of long non-coding RNAs in peripheral blood mononuclear cells of non-segmental vitiligo

“…According to the Consensus on the treatment of vitiligo—Brazilian Society of Dermatology, vitiligo can be categorized into clinical classes, including segmental vitiligo and non-segmental vitiligo. [ 16 ] However, non-segmental vitiligo is the most common type. NSV and SV were believed to have distinct underlying pathogenetic mechanisms due to their different clinical presentations, with the neuronal hypothesis or somatic mosaicism favored for the segmental form.…”

Stability: Concept, relevance, inducing and maintaining it

“…It is defined as “a patient reporting no new lesions, no progression of existing lesions, and absence of KP during the past 1 year.” Brazilian guidelines follow the same 1 year as a consensus for opting for surgical treatment. Both of these are based on expert recommendations and not on systematic comparative studies 13 …”

“…Both of these are based on expert recommendations and not on systematic comparative studies. 13 European Dermatology Forum (EDF) guidelines recommend that surgery should be reserved for patients with segmental vitiligo (SV) and other localized forms of vitiligo, after the documented failure of medical interventions. For NSV, only stable diseases with negative KP are eligible, but the risk of relapse must be explained thoroughly to the patient.…”

Update on the pathogenesis of vitiligo

“…There is currently no definitive cure for vitiligo; however, several treatments have shown favorable results, achieving some degree of repigmentation in over 80% of cases. 5 The recent advance in the understanding of its pathogenesis has promoted new therapeutic alternatives, which allude to a more hopeful future for patients.…”