This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (53)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Evidence-Based Medicine  • Dermatology, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

M. D. Njoo, MD; W. Westerhof, MD, PhD; J. D. Bos, MD, PhD; P. M. M. Bossuyt, MD, PhD

Arch Dermatol. 1999;135:1514-1521.

Objective  To develop and introduce evidence-based guidelines for the treatment of vitiligo in children and in adults.

Patients and Setting  Patients, residents, and dermatologists from the Department of Dermatology, Academic Medical Center, University of Amsterdam, and the Netherlands Institute for Pigmentary Disorders in Amsterdam.

Design  Scientific evidence obtained from 3 systematic reviews of the literature was combined with the results of 2 questionnaires and interviews of potential users of the guidelines, 3 internal expert meetings, and 1 local expert meeting, during which preliminary guidelines were presented and commented on. A final version of the guidelines was synthesized and disseminated among potential users. Six months after the introduction of these guidelines, their use was evaluated.

Results  Before the development of the guidelines, there was no uniformity in treatment selection, and there was a variability in estimates of treatment outcome. The meta-analysis showed class 3 corticosteroids and narrowband UV-B to be the most effective and safest therapies for localized and for generalized vitiligo, respectively. From another systematic review, it could be concluded that patients with segmental, stable, or lip-tip vitiligo could be successfully treated with most autologous transplantation methods. For vitiligo universalis, results of the systematic review showed that depigmentation using monobenzone or a Q-switched ruby laser was equally effective. The final version of the guidelines consisted of a treatment scheme together with detailed treatment protocols. Implementation of the guidelines was evaluated in 5 physicians. After the introduction of these guidelines, they were followed in most adult cases with vitiligo (71% of patients with localized vitiligo, 82% with generalized vitiligo, 100% with stable or segmental vitiligo, and 80% with universal vitiligo). In children with vitiligo, the physicians adhered to the guidelines for 52% of the cases.

Conclusions  Guidelines for the treatment of vitiligo can be successfully developed and disseminated for daily clinical practice. The results of the implementation of these guidelines should be confirmed in other centers involving more clinicians.

From the Netherlands Institute for Pigmentary Disorders (Drs Njoo and Westerhof) and the Departments of Dermatology (Dr Njoo, Westerhof, and Bos) and Clinical Epidemiology and Biostatistics (Dr Bossuyt), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Dermatology Reader's Choice: Continuing Medical Education
Arch Dermatol. 1999;135(12):1569-1570.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Vitiligo: To Treat or Not to Treat
Lim and Hexsel
Arch Dermatol 2007;143:643-646.
FULL TEXT  

Erbium:YAG Laser and Cultured Epidermis in the Surgical Therapy of Stable Vitiligo
Guerra et al.
Arch Dermatol 2003;139:1303-1310.
ABSTRACT | FULL TEXT  

Vitiligo: The Evolution of Cultured Epidermal Autografts and Other Surgical Treatment Modalities
Yaar and Gilchrest
Arch Dermatol 2001;137:348-349.
FULL TEXT  

Guidelines for Treatment of Vitiligo: Is an Update Pending If Recommendations for Children Are Not Followed?
Mohrenschlager et al.
Arch Dermatol 2000;136:1173-1174.
FULL TEXT