Whitton M E, Ashcroft D M, Barrett C W, Gonzalez U
Cochrane Database Syst Rev. 2006 Jan 25(1):CD003263. doi: 10.1002/14651858.CD003263.pub3.
Around 1% of the world's population has vitiligo, which causes a loss of skin colour in patches. The methods currently available to treat vitiligo are largely unsatisfactory and vary widely between cultures and within health systems.
To assess the effects of interventions used to manage vitiligo.
We searched the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and other databases (last searched September 2004). Reference lists of articles and conference proceedings were searched. Authors of reviews were contacted.
Randomised controlled trials (RCTs).
At least two reviewers independently assessed study eligibility and methodological quality and carried out data extraction. The included studies compared different interventions and used different outcome measures so we considered it inappropriate to combine their results.
Nineteen trials with a total of 1350 participants were included. The RCTs generally had low numbers of participants and only RCTs of repigmentation and not other methods of managing vitiligo were able to be included. In one study, potent topical steroids resulted in better repigmentation than placebo and they were also better than oral psoralens plus sunlight in another study (RR 4.70 95% CI 1.14 to 19.39) although their long-term use is limited by adverse effects. Two studies suggested that topical calcipotriol enhanced repigmentation rates from PUVAsol and PUVA when compared with placebo. Another two studies showed higher repigmentation rates with oral PUVAsol versus placebo plus sunlight (RR 19.20 95% CI 1.21 to 304.50 in 79 adults and RR 2.29 95% CI 1.14 to 4.58 in a study of 50 children). The safety of these interventions was poorly described and none of the studies was able to demonstrate long term benefits. Very few studies were carried out on children or included segmental vitiligo. No trials evaluating micropigmentation, melanocyte transplantation, depigmentation or cosmetic camouflage could be found. Despite the fact that the main impact of vitiligo is psychosocial only one study on psychological therapy was found and it is awaiting assessment.
AUTHORS' CONCLUSIONS: This review has found some evidence to support existing therapies for vitiligo, but the different designs and outcome measurements, lack of quality of life measures and adverse effect reporting in the studies limit the usefulness of their findings. There is a pressing need for high quality randomised trials using standardised measures of repigmentation and which address relevant clinical outcomes including quality of life.
全球约1%的人口患有白癜风，该病会导致皮肤出现斑块状色素脱失。目前治疗白癜风的方法大多不尽人意，且在不同文化和卫生系统之间差异很大。
评估用于治疗白癜风的干预措施的效果。
我们检索了Cochrane皮肤组专业注册库、Cochrane对照试验中央注册库、MEDLINE、EMBASE、AMED及其他数据库（最近一次检索时间为2004年9月）。还检索了文章的参考文献列表和会议论文集。联系了综述的作者。
随机对照试验（RCT）。
至少两名综述作者独立评估研究的纳入资格和方法学质量，并进行数据提取。纳入的研究比较了不同的干预措施，且使用了不同的结局指标，因此我们认为合并这些研究结果并不合适。
共纳入19项试验，总计1350名参与者。这些随机对照试验的参与者数量普遍较少，且仅纳入了色素再生方面的随机对照试验，未纳入白癜风的其他治疗方法。在一项研究中，强效外用糖皮质激素比安慰剂能更好地促进色素再生，在另一项研究中，其效果也优于口服补骨脂素加光照（RR 4.70，95%可信区间1.14至19.39），不过其长期使用会受到不良反应的限制。两项研究表明，与安慰剂相比，外用卡泊三醇可提高补骨脂素浴和补骨脂素紫外线A光化学疗法（PUVA）的色素再生率。另外两项研究显示，口服补骨脂素浴与安慰剂加光照相比，色素再生率更高（79名成年人中RR 19.20，95%可信区间1.21至304.50；一项50名儿童的研究中RR 2.29，95%可信区间1.14至4.58）。这些干预措施的安全性描述不足，且没有一项研究能够证明其长期益处。针对儿童开展的研究很少，或纳入节段性白癜风的研究也很少。未找到评估微色素沉着、黑素细胞移植、色素脱失或美容遮瑕的试验。尽管白癜风的主要影响是心理社会方面的，但仅找到一项关于心理治疗的研究，且该研究尚待评估。
本综述发现了一些证据支持现有的白癜风治疗方法，但研究中不同的设计和结局测量方法、缺乏生活质量测量以及不良反应报告，限制了这些研究结果的实用性。迫切需要开展高质量的随机试验，采用标准化的色素再生测量方法，并涉及包括生活质量在内的相关临床结局。
