Vitiligo Treatment Consensus (2009 Edition)
Treatment principles
(I), progressive vitiligo
1.Unusual type.
①Limited type: topical glucocorticoids (referred to as hormones) or calcium-regulated neurophosphatase inhibitors (tacrolimus, pimecrolimus), etc. can also be used topically with low concentration of photosensitizing drugs, such as concentration <0.1% of 8-methoxazole (8-MOP); local phototherapy optional narrow-spectrum medium-wave ultraviolet light (NB-UVB), 308nm
Excimer laser and excimer light, high-energy ultraviolet light, etc.
②Distribution type, pancytopenia type and extremity type: Chinese herbal medicine, immunomodulators, consider systemic glucocorticoids. Phototherapy and topical topical drugs refer to the progressive limited type.
(2) Segmental type: refer to the treatment of progressive limited type.
(II), stable stage vitiligo.
1, common type.
①Limited type: topical photosensitizers (such as furanocoumarins 8-MOP, etc.), hormones, nitrogen mustard, calcium-regulated neurophosphatase inhibitors, vitamin D3 derivatives, etc.; autologous epidermal transplantation and melanocyte transplantation; local phototherapy refer to the progressive limited type or photochemotherapy.
②Disseminated, panniculitis and extremity type: phototherapy or photochemotherapy, such as NB-UVB, PUVA
etc.; Chinese herbal medicine; autologous epidermal transplantation or melanocyte transplantation (exposed site or site requested by the patient). Local topical drug treatment is referred to the stable stage limited type.
2. Segmental type.
Autologous epidermal transplantation or melanocyte transplantation, including autologous epidermal slice transplantation, microdermal slice transplantation, bladed thick skin slice transplantation, autologous non-cultured epidermal cell suspension transplantation, autologous cultured melanocyte transplantation, etc. Others refer to the stable stage limited treatment.
III. Treatment details
(i) Hormone therapy.
1.Topical topical hormone.
Suitable for progressive lesions with white spots involving <10% of the area. Super- or strong-acting hormones can be used continuously for 1-3 months or under the guidance of a specialist, or alternately with strong- and weak-acting or weak- and medium-acting hormones. Weak-acting hormones are relatively less effective, while strong-acting hormones are relatively more effective.
For adults, topical strong hormones are recommended. If there is no recoloration after 3~4 months of continuous topical hormone treatment, it indicates poor efficacy of hormone treatment and needs to be replaced by other treatment methods.
2. Systemic hormone use.
It is mainly applied to patients with pancytopenia progressive vitiligo. The actual hormone can be taken orally or intramuscularly to stabilize the progressive vitiligo as soon as possible. The actual fact is that you can get a lot more than just a few of the most popular and popular products.
After the effect, every 2~4 weeks decreasing 5mg to 5mg every other day, maintain for 3~6 months. Or compound betamethasone 1ml, intramuscular injection, once every 20-30 days, available 1~4 times.
(B) Phototherapy and photochemotherapy.
1. Local phototherapy.
NB-UVB treatment 2~3 times per week, 308nm single frequency excimer light, 308nm excimer laser helium-neon laser, high energy ultraviolet light.
2, whole body phototherapy.
Treatment 2~3 times per week, initial dose and next treatment dose adjustment is similar to local NB-UVB. NB-UVB is more convenient than PUVA
NB-UVB is more convenient than PUVA, the eyes do not need to be protected from light after treatment, and the phototoxic reaction is less. Patients for whom NB-UVB treatment is ineffective can be replaced with PUVA treatment.
3.Local photochemotherapy.
For limited vitiligo, local topical application of furanocoumarins (8-MOP, tincture of psoralen, etc.) + sunlight is a therapeutic and practical treatment option that can be used for adults and children over 5 years old.
4.Oral photochemotherapy.
It is suitable for patients with white spots involving >20% of body surface area, patients resistant to NB-UVB and topical PUVA treatment, and patients aged >12 years.
5.Photosensitizing drugs.
①Topical psoralen, coal tar preparations, etc.
②Chinese medicine photosensitizing drugs: bone marrow, dahurica.
(iii), transplantation therapy.
Suitable for stable vitiligo patients, especially for limited and segmental vitiligo patients, other types of vitiligo with exposed skin lesions can also be used.
The common transplantation methods include: autologous epidermal slice transplantation, micro skin slice transplantation, edge thick skin slice transplantation, autologous non-cultured epidermal cell suspension transplantation, autologous cultured melanocyte transplantation, single hair follicle transplantation, etc. Autologous epidermal transplantation is simple and feasible, and has good efficacy. The combination of transplantation treatment and phototherapy can improve the clinical efficacy.
(iv) Immunosuppressants.
Topical calcium-regulated neurophosphatase inhibitors include tacrolimus ointment and pimecrolimus cream.
(v) Vitamin D3 derivatives.
Topical calcitriol and tacalcitol can be used for the treatment of vitiligo and applied topically twice daily. Vitamin D3 derivatives can be combined with narrow-spectrum UVB, 308nm excimer laser, PUVA, etc.
(VI), Traditional Chinese medicine
(vii), Depigmentation treatment.
(viii), masking therapy.
(ix), children vitiligo.
Limited white spots: children <2 years old, can be treated with topical medium-acting hormones, using intermittent topical therapy is safer. Children >2 years old can be treated with topical medium- or strong-acting hormones. Topical calcium-regulated neurophosphatase inhibitors: tacrolimus ointment and pimecrolimus cream etc. Ye can be used for the treatment of vitiligo in children.
Rapidly progressive vitiligo lesions in children can be treated with small doses of hormones orally, and oral prednisone 5~10mg/d for 2~3 weeks is recommended. If necessary, the treatment can be repeated once more after 4~6 weeks.
(X) Adjuvant therapy.
Trauma and exposure to sunlight should be avoided, especially in the progressive phase. Vitamin supplementation may be helpful. Treatment of concomitant diseases. Psychological counseling.