The development of guidelines for the treatment of vitiligo

Objective: To develop and introduce evidence-based guidelines for the treat ment of vitiligo in children and in adults. Patients and Setting: Patients, residents, and dermatologists from the Depa rtment of Dermatology, Academic Medical Center, University of Amsterdam, an d the Netherlands institute for Pigmentary Disorders in Amsterdam. Design: Scientific evidence obtained from 3 systematic reviews of the liter ature was combined with the results of 2 questionnaires and interviews of p otential users of the guidelines, 3 internal expert meetings, and 1 local e xpert meeting, during which preliminary guidelines were presented and comme nted on. A final version of the guidelines was synthesized and disseminated among potential users. Six months after the introduction of these guidelin es, 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 treatme nt outcome. The meta-analysis showed class 3 corticosteroids and narrowband UV-B to be the most effective and safest therapies for localized and for g eneralized vitiligo, respectively. From another systematic review, it could be concluded that patients with segmental, stable, or lip-tip vitiligo cou ld be successfully treated with most autologous transplantation methods. Fo r vitiligo universalis, results of the systematic review showed that depigm entation using monobenzone or a Q-switched ruby laser was equally effective . The final version of the guidelines consisted of a treatment scheme toget her with detailed treatment protocols. Implementation of the guidelines was evaluated in 5 physicians. After the introduction of these guidelines, the y were followed in most adult cases with vitiligo (71% of patients with loc alized vitiligo, 82% with generalized vitiligo, 100% with stable or segment al 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 d eveloped and disseminated For daily clinical practice. The results of the i mplementation of these guidelines should be confirmed in other centers invo lving more clinicians.