加拿大白癜风管理共识指南。

IF 3.5 3区 医学 Q1 DERMATOLOGY
Dermatology and Therapy Pub Date : 2025-06-01 Epub Date: 2025-04-20 DOI:10.1007/s13555-025-01402-5
Vimal H Prajapati, Harvey Lui, Yvette Miller-Monthrope, Julien Ringuet, Irina Turchin, H Chih-Ho Hong, Charles Lynde, Kim A Papp, Jensen Yeung, Melinda J Gooderham
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引用次数: 0

摘要

白癜风仍然是一种高度繁重的疾病,与显著的自身免疫和社会心理合并症相关。尽管治疗领域长期以来一直以非适应症治疗为主,但新的治疗方法正在出现。关于如何安全有效地利用现有疗法的有限指导给医疗保健提供者带来了挑战。在这里,我们提供普遍接受的原则,共识的建议,和白癜风管理的治疗算法,作为一个小组开发的十位加拿大皮肤科医生与管理白癜风的专业知识。方法:三个阶段的过程包括确定主题和研究问题;进行系统的文献综述;并讨论/投票普遍接受的原则,共识声明,以及使用迭代共识过程的处理算法。结果:专家们达成了27项普遍接受的原则,10项共识声明和一种治疗算法。关于白癜风发病机制和色素再生生物学的教育可以帮助患者、护理人员和医疗保健提供者设定切合实际的治疗期望。治疗应侧重于色素沉着或稳定的进展,而不是色素沉着。局部治疗包括局部皮质类固醇,局部钙调磷酸酶抑制剂和局部Janus激酶抑制剂ruxolitinib乳膏。光疗,如窄带紫外线B和准分子激光/灯,可作为单一疗法或与其他治疗联合使用。适应症外全身治疗可能适用于不稳定或疾病进展迅速的患者。手术治疗可能适用于局部或稳定顽固性疾病的患者。维持治疗可能有助于降低疾病复发的风险。结论:对现有治疗方法的益处、风险和局限性的进一步明确支持了白癜风治疗指南和治疗算法的发展。疾病稳定和重新色素沉着是很大程度上可以实现的目标,特别是当患者对白癜风及其治疗方案有共同的理解时。本文的图形摘要是可用的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Canadian Consensus Guidelines for the Management of Vitiligo.

Introduction: Vitiligo remains a highly burdensome disease associated with significant autoimmune and psychosocial comorbidities. Although the therapeutic landscape has long been dominated by off-label therapy, new treatments are emerging. Limited guidance on how to safely and effectively utilize available therapies poses challenges for healthcare providers. Herein, we provide generally accepted principles, consensus recommendations, and a treatment algorithm for the management of vitiligo, as developed by a panel of ten Canadian dermatologists with expertise in managing vitiligo.

Methods: The three-phase process consisted of identifying themes and research questions; conducting a systematic literature review; and discussing/voting on generally accepted principles, consensus statements, and a treatment algorithm using an iterative consensus process.

Results: Experts agreed to 27 generally accepted principles, ten consensus statements, and a treatment algorithm. Education about vitiligo pathogenesis and repigmentation biology can help patients, caregivers, and healthcare providers set realistic expectations for treatment. Treatment should focus on repigmentation or stabilizing progression, rather than on depigmentation. Topical therapies include topical corticosteroids, topical calcineurin inhibitors, and the topical Janus kinase inhibitor ruxolitinib cream. Phototherapy, such as narrow-band ultraviolet B and excimer laser/lamp, can be used as monotherapy or in combination with other treatments. Off-label systemic therapies may be appropriate for patients with unstable or rapidly progressing disease. Surgical therapy may be suitable for patients with localized or stable recalcitrant disease. Maintenance therapy may help mitigate the risk of disease relapse.

Conclusion: Improved clarity around the benefits, risks, and limitations of available therapies has supported the development of robust guidelines and a treatment algorithm for vitiligo. Disease stabilization and repigmentation are goals that can largely be achieved, particularly when patients share a mutual understanding of vitiligo and its treatment options. A Graphical Abstract is available for this article.

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来源期刊
Dermatology and Therapy
Dermatology and Therapy Medicine-Dermatology
CiteScore
6.00
自引率
8.80%
发文量
187
审稿时长
6 weeks
期刊介绍: Dermatology and Therapy is an international, open access, peer-reviewed, rapid publication journal (peer review in 2 weeks, published 3–4 weeks from acceptance). The journal is dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of dermatological therapies. Studies relating to diagnosis, pharmacoeconomics, public health and epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to all clinical aspects of dermatology, such as skin pharmacology; skin development and aging; prevention, diagnosis, and management of skin disorders and melanomas; research into dermal structures and pathology; and all areas of aesthetic dermatology, including skin maintenance, dermatological surgery, and lasers. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols, and short communications. Dermatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an International and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. The journal appeals to a global audience and receives submissions from all over the world.
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