Repigmentation in vitiligo: position paper of the Vitiligo Global Issues Consensus Conference

Abstract

The Vitiligo Global Issues Consensus Conference (VGICC), through an international e-Delphi consensus, concluded that 'repigmentation' and 'maintenance of gained repigmentation' are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation, and the second section summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over 3 yr. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus.

International Initiative for Outcomes ( INFO ) for vitiligo: workshops with patients with vitiligo on repigmentation

“…A second e‐Delphi consensus exercise was conducted, with the aim to gain agreement on how best to measure repigmentation in target lesions in future RCTs. This international e‐Delphi exercise involved 94 panellists (patients, clinicians and journal editors) and reached a response rate of 94%; however, no agreement was reached on the best outcome measure to assess target repigmentation . The results of the second e‐Delphi survey were presented at the International Pigment Cell Conference in Singapore.…”

“…The results of the second e‐Delphi survey were presented at the International Pigment Cell Conference in Singapore. Following a prolonged face‐to‐face meeting and confidential voting among the Vitiligo Global Issues Consensus Group (VGICG) of international experts (clinicians, researchers and journal editors), an agreement was reached on the definition of a successful percentage of repigmentation being ≥ 80% …”

Involvement of non‐melanocytic skin cells in vitiligo

“…Treating vitiligo is still challenging and, in particular, lesions in acral regions (like hands and feet) and over the bony prominence, such as knees and elbows, are extremely resistant to standard treatments. Therefore, combining phototherapy or topical medications with physical strategies is increasingly recommended to manage resistant vitiligo patches . Recent experimental and clinical data support the hypothesis that inducing a cell regeneration process at the dermal level can improve the therapeutic response of vitiligo; this is evident in therapies such as fractional carbon dioxide (CO 2 ) laser, needling, peeling and platelet‐rich plasma (PRP).…”

Vitiligo as a skin memory disease: The need for early intervention with immunomodulating agents and a maintenance therapy to target resident memory T cells

“…Of course, compared to other chronic inflammatory skin disorders such as psoriasis or atopic dermatitis, immunomodulating agents alone might be sufficient to dampen skin inflammation but not to induce repigmentation. Indeed, UV‐light therapies inducing melanocyte activation and differentiation together with modulation of the immune response should be always considered to achieve repigmentation . As an example, in our department seven vitiligo patients initiated a treatment with methotrexate (15 mg/wk) that was first indicated for another chronic inflammatory condition associated with vitiligo (Table ).…”