Prognosis
Vitiligo is typically a progressive disease with an unpredictable clinical course.
Phases of partial repigmentation, depigmentation, or progression may follow. Complete repigmentation without treatment is extremely rare. Localised forms of vitiligo may remain stable and restricted to a limited area, but may also spread to become generalised. There are currently no clinical or laboratory biomarkers to predict the disease course in an individual patient.
Partial repigmentation in sun-exposed patches may predict a good treatment response. The majority of patients experience greater than 75% repigmentation when following first-line therapies. A general rule of thumb is to expect 25% improvement after 3 months, 50% improvement after 6 months, and 75% improvement after 9 months of therapy.
Long-standing disease, a segmental distribution, and poliosis are considered predictors of a less-favourable treatment outcome. Although 50% repigmentation rates in affected skin are highly significant in statistical terms, they may not be satisfactory to the patient.
Notably, glabrous skin such as the penis, hands, wrists, feet, and fingertips often do not respond at all.[58][59]
Use of this content is subject to our disclaimer