Segmental vitiligo treatment: past, present, and future = Segmental vitiligo treatment: past, present, and future

다국어 초록 (Multilingual Abstract)

Compared with non-segmental vitiligo (NSV) segmental vitiligo (SV) is a distinct type of vitiligo in terms of its clinical features, natural course, and response to treatment. In SV, white macules are usually localized to one segment on only one side of the body, however, in NSV white macules can occur at any body location and disease activity tends to persist throughout the life of the patient. Thus, the course of SV seems to be predictable while that of NSV is unpredictable. Treatment guidelines of SV may be easier to determine than those of NSV. The treatment modalities for vitiligo largely consist of medical and surgical treatments. Medical management includes topical corticosteroids and immunomodulators, and phototherapy such as narrow-band UVB (NB-UVB) and excimer laser. If medical treatment is unsatisfactory, surgical treatments such as autologous epidermal grafting can be considered. Based on previous reports and our experiences, we proposed a set of treatment guidelines in SV. Treatments such as topical corticosteroids and topical calcineurin inhibitors, as well as phototherapy, including NB-UVB and excimer laser are helpful for SV. Combination of topical treatment and phototherapy seems to be more efficacious in SV. In addition, disease duration in SV is important to predict the response to medical treatment. Thus, as first-line therapy, we recommend the combination of topical treatment and phototherapy to be initiated as early as possible. If medical treatment is not effective any more, surgical treatment needs to be considered. In addition, our experience suggests that phototherapy is not helpful in SV patients with the majority of hairs in lesional skin being white. In these cases, surgery can be considered in order to avoid delay as well as unnecessary and inefficacious treatment.