Management of vitiligo. Results of a questionnaire among dermatologists inThe Netherlands

Background Several therapeutic options are available for the treatment of v itiligo. Concern exists that there is no uniform approach towards the manag ement of vitiligo among Dutch dermatologists. Methods A written survey concerning the management of vitiligo was sent to 332 dermatologists in The Netherlands. Results The response rate was 86%. "Giving information and reassurance conc erning the nature of disease" was regarded by most dermatologists (68%) as being the most important goal in the management of vitiligo. Only 16% of th e dermatologists aimed for active treatment in vitiligo. The reported thera py choices in children resembled those of adults, except that slightly more dermatologists did not prescribe active therapy in children. Nine differen t therapeutic modalities were mentioned as first choice therapies. Topical corticosteroids were indicated by most dermatologists as first choice thera py (241 out of 266, i.e. 91%); however, only 2% indicated that 50% or more of the patients achieved a successful treatment; 66% found that less than 2 5% of the patients were successfully treated with topical corticosteroids. Only 15% of the respondents reported that 50% or more of the patients were treated successfully with narrow-band UVB. The observed response profile to broad-band UVB therapy was found to be comparable with that of narrow-band UVB. The classical therapy with oral psoralen plus UVA (PUVA) was prescrib ed as first choice therapy by only 12% (32 out of 266) of the dermatologist s. Only 6% of these respondents observed that 50% or more of the patients a chieved successful therapy using oral PUVA. The recommended maximum treatme nt duration for topical corticosteroids, oral PUVA, and UVB therapy was fou nd to vary from 3 to 12 months. Conclusions Most dermatologists in The Netherlands do not offer active trea tment in vitiligo, probably because the estimated effectiveness of (nonsurg ical) repigmentation therapy is low. In cases where treatment is prescribed , there appears to be no consensus on the choice of therapies and treatment strategies. The development of practice guidelines may be helpful in reduc ing inappropriate care and improving treatment outcome.