Vitiligo is a chronic, unpredictable disease causing a loss of skin colour in patches. People of all ages and from all ethnic backgrounds can develop the disease. Vitiligo does not cause physical symptoms but because of its unsightly appearance, particularly on dark or tanned skin it can have considerable impact both psychologically and socially. Many ways of restoring normal colour to the skin have been tried but improvement is usually short-lived. The causes of vitiligo are not yet clearly understood, so many treatments have been developed on the basis of limited scientific evidence. There is no cure, and no way of limiting the spread of the disease has so far been found.
We found twice as many trials (38) as we did in the original review (19) making a total of 57 studies, with 3139 participants overall. Most of the studies had fewer than 50 participants and few lasted longer than 6 months.
The studies, which covered a wide range of treatments, also used many different ways of assessing the degree of repigmentation. Only 28 of the trials reported quality of life and greater than 75% repigmentation. There were many different designs: some studies looked at individual patches whereas others compared participants. Most of the trials assessed combination treatments using ultraviolet light to enhance repigmentation. In general, combination studies reported better results.
None of the trials reported long-term benefit (i.e. sustained repigmentation lasting at least two years). Results from this review should therefore be treated with caution.
Some studies described adverse effects, in particular those using topical corticosteroids, but in the combination studies it was difficult to ascertain which treatment caused these effects. There is a great need for an extensive and well planned programme of research to establish the causes of vitiligo and to find effective ways to manage this disease.