Vitiligo is classified into non`segmental type and segmental type[1]. Each type has a different clinical feature and natural history[2] Segmental vitiligo often starts early in life. It is almost always limited to one segment of the body and does not go over the opposite side of the body. It tends to spread rapidly and be stabilized in a few years. Thus,the course of segmental vitiligo is predictable, while that of non`segmental vitiligo is unpredictable. White hairs always seem to be associated with segmental vitiligo[3].The preferential management for segmental vitiligo includes topical corticosteroids and immunomodulators, phototherapy such as narrow-band UVB, and excimer laser[4].If medical treatments are unsatisfactory, surgical treatment such as epidermal grafting can be con`sidered.Recently, the treatment guideline for vitiligo was reported[5], but it has some limitatio`ns.
Based on previous reports and our experiences, we propose a treatment guideline for segmental vitiligo (Table 1).Recently we reported that medical treatments were not helpful in long-duration segmental vitiligo, demon`strating that disease duration is very important for the respon`siveness of medical treatment[6]. Thus, as a first line, we recommend combination of topical therapy and phototherapy as soon as possible. In addition, we found that phototherapy was not helpful in patients with segmental vitiligo who had the majority of white hairs in the lesional skin[7]. Therefore,we recommend that if the majority of hairs are white in the lesional skin, surgical therapy is indicated as a first line to avoid unnecessary treatment and wasting time with medical treatments.
Table 1 Treatment guideline in segmental vitiligo
First line Topical therapies (topical corticosteroids, calcineurin inhibitors) and narrow-band UVB therapy or targeted phototherapy including excimer laser for at least 3 months. If there is a respon`se, continue them for 1 year.
If the majority of hairs are white in the lesional skin, con`sider surgical therapy.
Second line
Con`sider surgical therapy if medical treatment is unsatisfactory.
We expect that this guideline will provide a definite decision for the treatment of segmental vitiligo.
Acknowledgment
We thank Taemin Lee (Jay Lee) for his excellent English proofreading.
Dong-Youn Lee, MD PhD
Sun-Chul Choi, MD
Department of Dermatology
Sungkyunkwan University
School of Medicine
Samsung Medical Center
Seoul
South Korea
Dong-Youn Lee, MD PhD
Department of Dermatology
Sungkyunkwan University School of Medicine
Samsung Medical Center
Seoul 135-710
South Korea
doi: 10.1111/j.1365-4632.2010.04694.x
References
1 Koga M, Tango T. Clinical features and course of type A and type B vitiligo. Br J Dermatol 1988; 118: 223–228.
2 Hann SK, Lee HJ. Segmental vitiligo: clinical findings in 208 patients. J Am Acad Dermatol 1996; 35: 671–674.
3 Lee DY, Park JH, Lee JH, et al. Is segmental vitiligo always associated with leucotrichia?: use of digital portable microscopy. Int J Dermatol 2009; 48: 1262.
4 Falabella R, Barona MI. Update on skin repigmentation therapies in vitiligo. Pigment Cell Melanoma Res 2009;22: 42–65.
5 Taïeb A, Picardo M. Clinical practice. Vitiligo. N Engl J Med 2009; 360: 160–169.
6 Lee DY, Park JH, Lee JH, et al. Poor respon`se of phototherapy in segmental vitiligo with leucotrichia: role of digital microscopy. Int J Dermatol 2010; in press.
7 Lee DY, Park JH, Lee JH, et al. Surgical treatment is indicated in long-duration segmental vitiligo. Dermatol Surg 2010; 36: 568–569.
@International Journal of Dermatology 2012
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