New International Vitiligo Task Force Recommendations

Until recently, there was a lack of internationally agreed-upon guidelines for the treatment of vitiligo. Recently, a significant breakthrough was achieved when 42 international vitiligo experts and 4 patient representatives collaborated and developed a consensus management strategy for vitiligo.¹ Their expert-based clinical practice recommendations encompass the latest evidence on topical and systemic therapies, phototherapies, interventional approaches, and innovative treatments.

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Background

Vitiligo causes significant psychological and social distress.² Managing this condition has been challenging, primarily because there were no international consensus-based guidelines. Patients often faced inconsistent treatment approaches, resulting in treatment inefficacy and frustration. In response, the International Vitiligo Task Force was established to develop internationally agreed-upon expert-based recommendations for the treatment of patients with vitiligo.

Methods

Development of the recommendations was a meticulously orchestrated process conducted via both online and live meetings that provided platforms for collaborative discussions and decision-making. At least 2 experts were assigned to each treatment topic to summarize the existing evidence.¹ A core group of 8 experts further refined the recommendations through a survey, resolving any remaining issues to reach a consensus on effective treatment strategies.¹ The recommendations were subsequently validated by the entire group during 2 live meetings, ensuring they were not only evidence-based but also reflective of the collective expertise and consensus of the vitiligo community.¹This methodology underscores the rigor and inclusivity of the process that contributed to the establishment of these practice recommendations.

Significance of Recommendations

Vitiligo has long posed a conundrum for dermatologists and patients seeking effective treatments. However, recent advancements in the field, as highlighted by the International Vitiligo Task Force’s consensus statement, bring fresh hope to those affected.

The consensus statement signifies the collaborative efforts of professionals worldwide to address the complex nature of vitiligo. These recommendations offer direct, practical, and evidence-based approaches for health care providers despite the heterogeneous nature of the condition.

Results and Recommendations

The International Vitiligo Task Force notes several pearls for administering therapies for patients with vitiligo.¹

Topical Therapies: Steroids, Calcineurin Inhibitors, JAK Inhibitors

• Topical corticosteroids (TCS) stabilize vitiligo; TCS or topical calcineurin inhibitors (TCI) are suitable for the face. TCS effectively repigment the face and neck.
• TCIs, especially for limited vitiligo, are safer than TCS and can be combined with UV light.
• The breakthrough topical Janus kinase (JAK) inhibitor ruxolitinib cream (Opzelura) shows promise with significant repigmentation.

Phototherapies

• Narrowband UVB (NB-UVB) is the go-to for widespread or fast-progressing vitiligo and has the potential to induce repigmentation.
• Home phototherapy is convenient but comes with cost and familiarity issues.
• Photochemotherapy and excimer devices offer alternatives, with excimer devices requiring shorter treatment durations.

Systemic Treatments

• Oral steroid minipulse therapy stops disease progression but poses challenges for repigmentation.
• Other immunosuppressants such as methotrexate and cyclosporine have limited evidence.
• Biologics are not currently recommended for vitiligo.

Other Systemic Interventions

• The use of antioxidants or vitamins lacks consensus due to study variations.

Surgical Interventions

• Surgical options include grafting techniques for stable nonsegmental vitiligo.

Depigmentation Strategies

• Monobenzyl ether of hydroquinone is an FDA-approved depigmenting agent.
• Cryotherapy and pigment lasers are options for physical depigmentation.

Innovative and Emerging Therapies

• Ongoing trials are exploring innovative approaches such as using JAK inhibitors, targeting IL-15, and modulating the vitiligo microbiome.

Early Intervention and Stabilization

Vitiligo treatment outcomes often hinge on the timing of therapeutic measures. Thus, the consensus statement underscores the importance of promptly addressing vitiligo because disease stabilization is an achievable goal in many cases. For patients and dermatologists alike, this underscores the importance of proactive care.

The Future of Vitiligo Therapy

The field of vitiligo treatment is dynamic and evolving. Promising developments, such as the use of JAK inhibitors and ongoing research into drugs affecting adaptive and innate immunity, are at the forefront of vitiligo research.¹ These innovations hold the potential to revolutionize vitiligo treatment, offering more effective and targeted therapies.

Conclusion

The International Vitiligo Task Force’s consensus statement marks a significant milestone in the management of vitiligo. Importantly, it reminds us that vitiligo is not an insurmountable challenge; rather, with early intervention and the promise of emerging therapies, disease stabilization and repigmentation are tangible goals. The recommendations outlined in this consensus statement will undoubtedly shape the trajectory of vitiligo care, addressing the unmet needs of patients on a global scale.

In the journey to conquer vitiligo, unity, collaboration, and evidence-based practice are our greatest allies, as demonstrated by the remarkable efforts of the International Vitiligo Task Force.

Isabella Tan is from Potomac, Maryland, and is a second-year medical student at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.

References

1. Seneschal J, Speeckaert R, Taïeb A, et al. Worldwide expert recommendations for the diagnosis and management of vitiligo: position statement from the International Vitiligo Task Force-Part 2: specific treatment recommendations. J EurAcad Dermatol Venereol. Published online September 15, 2023. doi:10.1111/jdv.19450

2. Ahmed jan N, Masood S. Vitiligo. In: StatPearls. StatPearls Publishing; 2023.