more to achieve complete repig mentation in some patients . |
have failed . Removing pigment in remaining skin to create uniform skin tone can be |
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For limited lesions , monochromatic |
cosmetically beneficial in some cases . 31 |
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excimer light therapy ( 308nm excimer |
laser ) may be preferred , as it is a tar- |
Surgery |
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geted treatment delivering a high dose of |
Surgery is indicated in clinically stable vit- |
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UV light . 28 |
iligo ( ie , no new vitiligo spots or enlarge- |
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Booth-based and hand and foot |
ment of pre-existing lesions for more |
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than one year ) with few lesions , which is unresponsive to other therapies . 32 This involves transfer of melanocyte-rich tissue |
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to vitiligo-affected regions , called cellular |
Maintenance therapy |
grafting . 32 |
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The recurrence rate after a year of discontinuing treatment may be up to 40 %.
29 , 30
Maintenance therapy should be continued
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Emerging therapies
Topical and systemic JAK inhibitors have
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for 6-12 months after satisfactory repigmentation to minimise risk for relapse .
The maintenance therapy may be in
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recently been found to be effective in the management of vitiligo . These medications can affect the immune pathway and are |
Figure 2 . Koebnerisation . |
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the form of topical , systemic treatments or phototherapy .
Other options Depigmentation therapy Depigmentation therapy with 20 % monobenzyl ether of hydroquinone applied topically may be considered for patients with extensive vitiligo covering more than 50 % of the body in whom conventional therapies
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thought to work best in conjunction with phototherapy .
In 2022 , 1.5 % ruxolitinib cream was approved by the FDA , demonstrating satisfactory efficacy and safety profiles . TGA approval is awaited in Australia .
Conclusion
In conclusion , vitiligo is a systemic immune-mediated inflammatory disease .
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There are safe and effective treatments available that can improve patients ’ health and quality of living .
Early recognition and proactive management are essential elements for a good clinical outcome .
References on request from kate . kelso @ adg . com . au
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Online resources
• Information for patients with vitiligo : skinhealthinstitute . org . au / skin-conditions / vitiligo
• Online support group : vitiligo . org . au
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