A systematic review of interventions for idiopathic guttate hypomelanosis.

Background: Idiopathic guttate hypomelanosis is a common benign leukoderma, the incidence of which increases with age. Treatment is often sought for cosmetic reasons. However, there is a paucity of information on effective treatments for this condition.

Objectives: To evaluate and compile the effects of interventions for idiopathic guttate hypomelanosis.

Evidence review: MEDLINE (through PUBMED), Web of Science, and Scopus databases were searched for interventions for idiopathic guttate hypomelanosis from inception through November 2023. Reference lists were searched for additional articles. Human randomized controlled trials (RCTs), clinical studies (non-RCTs), and case series studies (n>5) of topical, light, and energy-based devices and procedural interventions for idiopathic guttate hypomelanosis. Re-pigmentation was the primary outcome. At least two reviewers were involved in article screening, selection, data extraction, and quality assessment.

Results: We included 20 articles from 522 articles: 9 randomized studies and 11 quasi-experimental studies. The number of patients varied from 6 to 240, and the maximum number of lesions included was 2129. Thirteen studies used a quartile grading score to report outcomes. Half the randomized studies had a high risk of bias, and the outcome measures were heterogeneous across studies. However, the treatment modalities were well-tolerated.

Conclusion: A wide range of interventions are effective in idiopathic guttate hypomelanosis. Most modalities involved some form of therapeutic wounding. However, study design and methodology limitations must be considered for each intervention. There is a paucity of large randomized controlled trials with standardized outcome measures and follow-up data on the longetivity of re-pigmentation in idiopathic guttate hypomelanosis.