This website is intended for healthcare professionals in Switzerland

Disease_Management_header
Disease Management Mobile
Speech_Marks

“It’s been a rollercoaster journey – from not knowing what vitiligo was, to trying every medicine I could find and now embracing and accepting that I look different.”1

There are no approved treatments for vitiligo in Europe. In fact, 65% of European patients have been told their condition is completely untreatable.2 This means the only positive outcome many patients can work towards is acceptance instead of relief.

How to diagnose vitiligo

Diagnosing vitiligo correctly is key to helping patients better understand their condition and for HCPs to manage the disease. 45% of all patients in Europe have had their condition misdiagnosed.2

Icon_Checklist

Vitiligo diagnoses are based on:

  • Physical examination (with or without Wood’s lamp)4,5
  • Clinical history4
  • Laboratory tests (e.g. thyroid function, autoantibodies)4,6
  • Biopsy of lesional and non-lesional skin4
Icon_Progressive_Disease

Progressive disease is marked by:

  • Inflammatory, trichrome, and confetti-like lesions7
  • Koebner phenomenon — new vitiligo lesions appearing in areas of trauma7,8

What is the goal of vitiligo treatment?

Goal of vitiligo treatment

The goal of vitiligo therapy is:

  1. 1) Halt disease progression9
  2. 2) Promote repigmentation9-11
  3. 3) Prevent relapse9

 

Lesional skin repigmentation is a complex process which can take months to achieve.


Interventions_And_Repigmentation_Desktop

Right image adapted with permission from John Wiley & Sons, Inc. Gan EY, et al. Pigment Cell Melanoma Res. 2017;30(1):28-40. Copyright© 2017.

Interventions_And_Repigmentation_Mobile

Right image adapted with permission from John Wiley & Sons, Inc. Gan EY, et al. Pigment Cell Melanoma Res. 2017;30(1):28-40. Copyright© 2017.



Repigmentation – a slow and gradual process

Lesional skin repigmentation is a slow process which can take months to achieve.
It’s thought to occur via the:

  • Migration of melanocytes from perilesional skin12
  • And/or Migration of melanoblasts from stem cell reservoirs, such as hair follicles and sebaceous glands12

 

 

Areas with low, or no, hair follicle density such as mucosal or semimucosal surfaces, lips, wrists and genitals are resistant to repigmentation.12

 


Limitations of current disease management in Europe

There are no approved vitiligo treatments currently available in Europe.13


European Dermatology Forum Treatment Algorithm14

 Segmental Vitiligo or Non-Segmental Vitiligo Affecting <2-3% BSANon-Segmental Vitiligo
1LLocal corticosteroids or calcineurin inhibitorsStabilization with NB-UVB phototherapy in combination with systemic/topical therapies with or without localised UVB
2LLocalised NB-UVB phototherapySystemic steroid or immunosuppressants
3LSurgerySurgery
4L Depigmentation

Segmental Vitiligo or Non-Segmental Vitiligo Affecting <2-3% BSA

  • 1LLocal corticosteroids or calcineurin inhibitors
  • 2LLocalized NB-UVB phototherapy
  • 3LSurgery
  • 4L

Non-Segmental Vitiligo

  • 1LStabilization with NB-UVB phototherapy combination with systemic/topical therapies with or without localised UVB
  • 2LSystemic steroid or immunosuppressants
  • 3LSurgery
  • 4LDepigmentation

Treatment recommendations vary across EU countries*

 UKFranceItalyGermanySpain
 British Association of Dermatologists Guidelines (2021)6European Dermatology Forum Guidelines (2013)14*Italian Society of Dermatology Guidelines (2011)15German Vitiligo Working Group Recommendations (2021)16Consensus Document on Phototherapy (2005)17
1LTCS once daily or TCI (tacrolimus 0.1% bid) or intermittent regimen TCS topical tacrolimus*†TCI or TCS, NB-UVBCS (betamethasone 0.1-0.2% or clobetasol 0.05%)*TCI or TCS, and/or
phototherapy		No official treatment guidelines; scientific consensus for the use of phototherapy
2LNB-UVB ± TCS or TCI For rapidly progressive, consider oral betamethasone ± NB-UVBNB-UVB 311nm (for patches <20% BSA), UVA + TCS

In limited vitiligo
(2-3% BSA):TCS
(for extra-facial
involvement) or TCI
(in facial areas)


In non-limited
vitiligo (>3% BSA),
NB-UVB, systemic
therapy with
dexamethasone
(for progressive
disease), surgery
(for stable vitiligo
resistant to other
therapies), and
depigmentation
(after exhausting
all other therapeutic
options)

3L

Excimer laser + TCI for localised vitiligo

Surgery for stable SV/NSV on hands/feet

Surgery (for patients with stable disease >1 year and without Koebner phenomenon)PUVA 320-400nm (for patches >20% BSA)
4LDepigmentation for
extensive vitiligo on
visible sites		DepigmentationSurgery† depigmentation (for patches >50% BSA)
UK
British Association of Dermatologists Guidelines (2021)
1LTCS once daily or TCI (tacrolimus 0.1% bid) or intermittent regimen TCS topical tacrolimus
2LNB-UVB ± TCS or TCI For rapidly progressive, consider oral betamethasone ± NB-UVB
3LExcimer laser + TCI for localized vitiligo Surgery for stable SV/NSV on hands/feet Depigmentation for extensive vitiligo on visible sites
4L 
France
European Dermatology Forum Guidelines (2016-2020)
1LTCI or TCS, NB-UVB
2L
3LSurgery (for patients with stable disease >1 year and without Koebner phenomenon)
4L 
Italy
Italian Society of Dermatology Guidelines (2013)
1LCS (betamethasone 0.1-0.2% or clobetasol 0.05%)*
2LNB-UVB 311nm (for patches >20% BSA), UVA + TCS
3LPUVA 320-400nm ( for patches >20% BSA)
4LSurgery depigmentation (for patches >50% BSA)
Germany
German Vitiligo Working Group Recommendations (2011)
1LCosmetics (e.g. Makeup, sunscreen), TCI or TCS, and/or phototherapy
2LTreatment with topical cortico-steroids is the standard of care for all forms of Vitiligo with an affection of <3% of the body surface area (limited affection*).

Treatment prioritisation by lines of therapy not included but recommended to follow 2013 European Dermatology Forum Guidelines
3L
4L
Spain
Consensus Document on Phototherapy (2005)
1LPUVA 320-400 nm NB-UVB 311 nm
2LNo official guidelines but there is a scientific consensus for the use of phototherapy
3L
4L

BSA, body surface area; CS, corticosteroids; NB-UVB/A, narrow-band UVB/A radiation; NSV, non-segmented vitiligo; PUVA, photochemotherapy with psoralen plus UVA radiation; SV, segmented vitiligo; TCI, topical calcineurin inhibitors; TCS, topical corticosteroids.

*Recommendations for therapy vary between NSV and SV.

†For areas with thinner skin. ‡For non-segmental vitiligo; all other treatments are for both vitiligo classifications.

Current treatments are known to have limited success in their outcomes and can result in:

  • Low quality of repigmentation18,19
  • Short duration of response20,21
  • Uneven response in different body regions22,23
  • Low treatment compliance24,25

Sign up now to stay informed

  1. Kirpal’s story: What makes you different makes you beautiful. Published Winter 2020. Accessed August 2022. https://www.changingfaces.org.uk/story/kirpals-story-what-makes-you-different-makes-you-beautiful/
  2. Bibeau K, Harris J, et al. Diagnosis and Management of Vitiligo From the Perspectives of Patients and Healthcare Professionals: Findings From the Global VALIANT Study. Presented at: Maui Derm for Dermatologists; January 24, 2022; Grand Wailea, Maui, HI.
  3. Bibeau K, Hamzavi I, et al. Mental Health and Psychosocial Burden Among Patients Living With Vitiligo: Findings From the Global VALIANT Study. Presented at: Maui Derm for Dermatologists; January 24, 2022; Grand Wailea, Maui, HI.
  4. Drake LA, Dinehart SM, et al. Guidelines of Care for Vitiligo. American Academy of Dermatology. J Am Acad Dermatol. 1996;35(4):620-626.
  5. Gawkrodger DJ, Ormerod AD, et al. Guideline for the Diagnosis and Management of Vitiligo. Br J Dermatol. 2008;159(5):1051-1076.
  6. Eleftheriadou V, Atkar R, et al. British Association of Dermatologists Guidelines for the Management of People With Vitiligo. Br J Dermatol. 2022;186(1):18-29.
  7. Bergqvist C, Ezzedine K. Vitiligo: Focus on Pathogenesis and its Therapeutic Implications. J Dermatol. 2021;48(3):252-270.
  8. Njoo MD, Das PK, et al. Association of the Köbner Phenomenon With Disease Activity and Therapeutic Responsiveness in Vitiligo Vulgaris. Arch Dermatol. 1999;135(4):407-413.
  9. Migayron L, Boniface K, et al. Vitiligo, From Physiopathology to Emerging Treatments: A Review. Dermatol Ther. 2020;10(6):1185-1198.
  10. Gan EY, Eleftheriadou V, et al. Repigmentation in Vitiligo: Position Paper of the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2017;30(1):28-40.
  11. Rosmarin D, Pandya AG, et al. Ruxolitinib Cream for Treatment of Vitiligo: A Randomised, Controlled, Phase 2 Trial. Lancet. 2020;396(10244):110-120.
  12. Birlea SA, Goldstein NB, Norris DA. Repigmentation Through Melanocyte Regeneration in Vitiligo. Dermatol Clin. 2017;35(2):205-218.
  13. Incyte. Dermatology. Accessed October 2022. https://incyte.com/dermatology.
  14. Taieb A, Alomar A, et al. Guidelines for the Management of Vitiligo: The European Dermatology Forum Consensus. Br J Dermatol. 2013;168(1):5-19.
  15. SIDeMaST. Accessed August 2022. http://www.sidemast.org/download/sidemast_20140609163719.pdf
  16. Böhm M. Diagnostik und Therapie der Vitiligo. Published online April 23, 2021. Accessed August 2022. https://www.awmf.org/uploads/tx_szleitlinien/013-093l_S1_Diagnostik-Therapie-Vitiligo_2021-04.pdf
  17. Carrascosa JM, Gardeazábal J et al. Consensus Document on Phototherapy: PUVA Therapy and Narrow-Band UVB Therapy. Actas Dermosifiliogr. 2005;96(10):635-658.
  18. Kwok YKC, Anstey AV, et al. Psoralen Photochemotherapy (PUVA) is Only Moderately Effective in Widespread Vitiligo: A 10-Year Retrospective Study. Clin Exp Dermatol. 2002;27(2):104-110.
  19. Yones SS, Palmer RA, et al. Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UV-A therapy vs Narrowband-UV-B therapy. Arch Dermatol. 2007;143(5):578-584.
  20. Boone B, Ongenae K, et al. Topical Pimecrolimus in the Treatment of Vitiligo. Eur J Dermatol EJD. 2007;17(1):55-61.
  21. Kumaran M, Kaur I, et al. Effect of Topical Calcipotriol, Betamethasone Dipropionate and Their Combination in the Treatment of Localized Vitiligo. J Eur Acad Dermatol Venereol. 2006;20(3):269-273.
  22. Doghaim NN, Gheida SF, et al. Combination of Fractional Carbon Dioxide Laser With Narrow Band Ultraviolet B to Induce Repigmentation in Stable Vitiligo: A Comparative Study. J Cosmet Dermatol. 2019;18(1):142-149.
  23. Stinco G, Trevisan G, Buligan C, et al. Narrow Band-Ultraviolet B Versus Clobetasol Propionate Foam in the Treatment of Vitiligo: A Retrospective Study. Dermatol Ther. 2013;3(1):95-105.
  24. Abraham S, Raghavan P. Myths and Facts About Vitiligo: An Epidemiological Study. Indian J Pharm Sci. 2015;77(1):8-13.
  25. Alsubeeh NA, Alsharafi AA, et al. Treatment Adherence Among Patients with Five Dermatological Diseases and Four Treatment Types -A Cross-Sectional Study. Patient Prefer Adherence. 2019;13:2029-2038.
Paint_Edge_Gradient
Paint_Edge_Gradient-mobile