Abstract
Background
The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed.
Objectives
To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo.
Methods
In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings.
Results
The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients.
Conclusions
These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.
CONFLICT OF INTEREST STATEMENT
Nanja van Geel MD, PhD received grants, is consultant and/or investigator for AbbVie, Incyte, Merck/MSD, Pfizer and Sun Pharma; and is chair of the Vitiligo Task Force for the European Academy of Dermatology and Venereology (EADV). She was involved in the development of several measurement instruments for vitiligo. Khaled Ezzedine MD, PhD has served as a consultant for AbbVie, Incyte Corporation, Pfizer, Pierre Fabre Pharmaceuticals, Merck/MSD and Almirall. Amit G. Pandya MD has served as an investigator for Incyte. He is a consultant for AbbVie, Avita Medical, Immune Tolerance Network, Incyte, Pfizer, Thalocan, Trifecta, TWi, Viela Bio, Vyne, and Villaris and holds stock options for Tara Medical and Zerigo Health. Thierry Passeron MD, PhD received consultancies fees from Abbvie, Incyte, Pfizer, Vyne therapeutics and Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from from Abbvie, Incyte, Pfizer, Vyne therapeutics. Albert Wolkerstorfer MD, PhD, is consultant for InCyte, Novartis, AvitaMedical, Candela and Lumenis. Jung Min Bae MD, PhD has served as a consultant for Pfizer, AbbVie, LaserOptek, Ilooda and Cutech Korea. Viktoria Eleftheriadou MD, PhD VE is a consultant for Incyte, Abbvie, Pfizer and Almirall. Samia Esmat MD is consultant for Pfizer. Pearl Grimes MD conducts clinical trials, for which the Vitiligo & Pigmentation Institute of Southern California receives financial support for purposes of conducting these trials, from Procter & Gamble, Clinuvel, L’Oreal, Johnson & Johnson, LaserOptek, Mother Science, Incyte, Pfizer, AbbVie/Allergan and SkinBetterScience. Dr. Grimes receives no direct compensation for this work. Somesh Gupta MD is conducting a clinical trial sponsored by Pfizer on Abrocitinib and Ritlecitinib. Iltefat H. Hamzavi MD is Consultant to Abbvie, Pfizer, Incyte, UCB, Boerhinger Ingelheim, Sonoma, Union therapeutics, Novartis, Jansen, Avita, Galderma and is Investigator for Lenicura, Pfizer, Incyte, Avita, L’oreal/La Roche Posay. He is also Board member and Past-president of the HS foundation and Global Vitiligo foundation. John E. Harris MD, PhD, 3rd Rock Venture – Consultant (Fees); AbbVie, Inc – Consultant (Fees); Aclaris Therapeutics, Inc – Consultant (Fees), Investigator (Grants/Research Funding); Admirx—Consultant (Fees); Aldena—Consultant (Fees), Founder (Stock); Almiral—Consultant (Fees); AnaptysBio—Consultant (Fees); Avita—Consultant (Fees); BiologicsMD—Consultant (Fees); Boston Pharma—Consultant (Fees); BridgeBio—Consultant (Fees); Celgene—Investigator (Grants/Research Funding); Cogen Therapeutics—Consultant (Fees); Dermavant—Consultant (Fees), Investigator (Grants/Research Funding); Dermira—Consultant (Fees); EMD Serono—Consultant (Fees), Investigator (Grants/Research Funding); Frazier Management—Consultant (Fees); Genzyme/Sanofi—Consultant (Fees), Investigator (Grants/Research Funding); Granular Therapeutics, Inc—Consultant (Fees); Incyte—Consulting (Fees), Investigator (Grants/Research Funding), Equity; Janssen—Consultant (Fees); LEO Pharma—Consultant (Fees), Investigator (Grants/Research Funding); Matchpoint Therapeutics—Consultant (Fees); Merck—Consultant (Fees); NIRA Biosciences—Consultant (Fees), Founder (Stock); Pandion—Consultant (Fees); Pfizer—Consultant (Fees), Investigator (Grants/Research Funding); Platelet Biogenesis—Consultant (Fees); Rheos Medicines—Consultant (Fees), Investigator (Grants/Research Funding), Equity (Stock); Sonoma Biotherapeutics—Consultant (Fees); Steifel/GSK—Investigator (Grants/Research Funding); Sun Pharmaceuticals—Consultant (Fees), Investigator (Grants/Research Funding); Temprian Therapeutics—Consultant (Fees); TeVido BioDevices—Consultant (Fees), Investigator (Grants/Research Funding), Equity (Stock); Twi Biotech—Consultant (Fees); Villaris Therapeutics—Consulting (Fees), Investigator (Grants/Research Funding), Founder (Stock); Vimela Therapeutics—Consultant (Fees), Founder (Stock); Villaris Therapeutics was recently acquired by Incyte. Sang Ho Oh MD, PhD has served as a consultant for Merck/MSD. Richard H. Huggins MD has served as an investigator for Arcutis, Avita, Clinuvel, Incyte, Pfizer and The Immune Tolerance Network; and is Treasurer of The Global Vitiligo Foundation. Eric Lan MD, PhD, has served for Pfizer, Dermira (Eli Lilly), Abbvie, Teva Pharmaceutical, Cerner Enviza clinical trials. None of the trials focus on vitiligo. Caroline Le Poole PhD is the CSO of Temprian Therapeutics, promoting the clinical translation of HSP70iQ435A for the treatment of vitiligo. Harvey Lui MD is a consultant (fees to professional medical corporation) for Incyte and has been a clinical investigator (fees to institution) for Pfizer in vitiligo. Jung Min Bae MD, PhD has served as a consultant for Pfizer, AbbVie, LaserOptek, Ilooda and Cutech Korea. Noufal Raboobee MD has received honoraria from AbbVie, Pfizer, Novartis, Lilly, Janssen and Sanofi, is the President of the Dermatology Society of South Africa and President of the Vitiligo Society of South Africa. David Rosmarin MD received honoraria as a consultant for AbbVie, Abcuro, AltruBio, Arena, Boehringer-Ingelheim, Bristol Meyers Squibb, Celgene, Concert, CSL Behring, Dermavant, Dermira, Incyte, Janssen, Kyowa Kirin, Lilly, Novartis, Pfizer, Regeneron, Recludix, Revolo Biotherapeutics, Sanofi, Sun Pharmaceuticals, UCB, VielaBio; has received research support from AbbVie, Amgen, Bristol Meyers Squibb, Celgene, Dermira, Galderma, Incyte, Janssen, Lilly, Merck, Novartis, Pfizer, and Regeneron Pharmaceuticals Inc; and has served as a paid speaker for AbbVie, Amgen, Bristol Meyers Squibb, Celgene, Dermavant, Incyte, Janssen, Lilly, Novartis, Pfizer, Regeneron Pharmaceuticals Inc. and Sanofi. Tamio Suzuki MD, PhD has served as a consultant for AbbVie, Pfizer, J-TEC and Pola; and is the secretary general of the Japanese Society of Vitiligo. Mauro Picardo MD, received grants or honoraria from PPM, Naos, Incyte and Pfizer and has a patent on Pioglidazone in Vitiligo. Julien Seneschal MD, PhD received grants and/or honoraria from AbbVie, Bristol Myers Squibb, Calypso Biotech, Eli Lilly, Incyte, LEO Pharma, Novartis, Pfizer, Pierre Fabre, Sanofi, Sun Pharmaceuticals and Viela Bio; and has a patent on MMP9 inhibitors and uses thereof in the prevention or treatment of a depigmenting disorder and three-dimensional model of depigmenting disorder. All other co-author have no disclosure to declare.
Image Credit: Envato Elements
