Njoo M D, Westerhof W, Bos J D, Bossuyt P M
Netherlands Institute for Pigmentary Disorders, Academic Medical Center, University of Amsterdam.
Arch Dermatol. 1999 Dec;135(12):1514-21. doi: 10.1001/archderm.135.12.1514.
To develop and introduce evidence-based guidelines for the treatment of vitiligo in children and in adults.
Patients, residents, and dermatologists from the Department of Dermatology, Academic Medical Center, University of Amsterdam, and the Netherlands Institute for Pigmentary Disorders in Amsterdam.
Scientific evidence obtained from 3 systematic reviews of the literature was combined with the results of 2 questionnaires and interviews of potential users of the guidelines, 3 internal expert meetings, and 1 local expert meeting, during which preliminary guidelines were presented and commented on. A final version of the guidelines was synthesized and disseminated among potential users. Six months after the introduction of these guidelines, their use was evaluated.
Before the development of the guidelines, there was no uniformity in treatment selection, and there was a variability in estimates of treatment outcome. The metaanalysis showed class 3 corticosteroids and narrowband UV-B to be the most effective and safest therapies for localized and for generalized vitiligo, respectively. From another systematic review, it could be concluded that patients with segmental, stable, or lip-tip vitiligo could be successfully treated with most autologous transplantation methods. For vitiligo universalis, results of the systematic review showed that depigmentation using monobenzone or a Q-switched ruby laser was equally effective. The final version of the guidelines consisted of a treatment scheme together with detailed treatment protocols. Implementation of the guidelines was evaluated in 5 physicians. After the introduction of these guidelines, they were followed in most adult cases with vitiligo (71% of patients with localized vitiligo, 82% with generalized vitiligo, 100% with stable or segmental vitiligo, and 80% with universal vitiligo). In children with vitiligo, the physicians adhered to the guidelines for 52% of the cases.
Guidelines for the treatment of vitiligo can be successfully developed and disseminated for daily clinical practice. The results of the implementation of these guidelines should be confirmed in other centers involving more clinicians.
制定并推出基于循证医学的儿童及成人白癜风治疗指南。
来自阿姆斯特丹大学学术医学中心皮肤科、阿姆斯特丹荷兰色素紊乱研究所的患者、住院医师及皮肤科医生。
从3篇文献系统评价中获取的科学证据,与2份针对指南潜在使用者的问卷调查及访谈结果、3次内部专家会议和1次当地专家会议的结果相结合,在这些会议上展示并讨论了初步指南。综合得出指南的最终版本并在潜在使用者中传播。在推出这些指南6个月后,对其使用情况进行了评估。
在指南制定之前,治疗选择缺乏一致性,治疗结果的评估存在差异。荟萃分析表明,3类皮质类固醇和窄谱中波紫外线分别是局限性和泛发性白癜风最有效、最安全的治疗方法。从另一篇系统评价中可以得出结论,节段性、稳定型或唇周白癜风患者可通过大多数自体移植方法成功治疗。对于泛发性白癜风,系统评价结果表明,使用单苯甲醚或调Q红宝石激光进行色素脱失治疗同样有效。指南的最终版本包括一个治疗方案以及详细的治疗协议。在5名医生中对指南的实施情况进行了评估。在推出这些指南后,大多数成年白癜风患者遵循了这些指南(局限性白癜风患者的71%、泛发性白癜风患者的82%、稳定型或节段性白癜风患者的100%以及泛发性白癜风患者的80%)。在儿童白癜风患者中,医生在52%的病例中遵循了这些指南。
可以成功制定并传播白癜风治疗指南用于日常临床实践。这些指南的实施结果应在其他有更多临床医生参与的中心得到证实。