Kong Yan Ling, Ching Vanessa Hui Ling, Chuah Sai Yee, Thng Tien Guan
National Skin Centre, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Indian J Dermatol Venereol Leprol. 2017 Sep-Oct;83(5):625. doi: 10.4103/ijdvl.IJDVL_650_16.
Late-onset vitiligo, defined as being aged 50 years and above at the point of clinical onset, remains poorly characterized till now.
This study aims to describe the clinical characteristics and treatment response of patients with late-onset vitiligo.
We retrospectively reviewed the case records of all patients diagnosed with late-onset vitiligo, from January 1, 2010 to December 31, 2014. Information obtained included patient demographics, characteristics of vitiligo and treatment responses.
Of the 3128 patients diagnosed with vitiligo over the 5-year period, 461 (14.7%) had late-onset disease. The study had more females (n = 260, 56.4%) than males, with an average onset age of 59.4 ± 7.4 years. Majority of patients were Chinese (n = 308, 66.8%) and 45 (9.8%) patients had an associated autoimmune disease. Focal vitiligo, defined as the localized presence of depigmented patches, was most common (n = 209, 45.3%). Treatment response was evaluated in 359 patients, of which 216 received monotherapy (topical creams: n = 210, 97.2%; phototherapy: n = 6, 2.8%) and 143 received both modalities. Fifty six (15.6%) patients received oral steroids. Patients who were treated with both topical creams and phototherapy yielded better clinical responses compared to those on monotherapy (P < 0.001) with 56.6% (n = 81) of them achieving good epidermal repigmentation, defined as >50% return of pigmentation compared to baseline (vs. n = 66, 30.6% in the monotherapy group). The choice of phototherapy (targeted, narrowband ultraviolet B or psoralen + ultraviolet A) did not significantly affect clinical response (P = 0.774).
This study is limited by its retrospective nature, the nonstandardized documentation resulting in the inability to determine disease progression and associated metabolic comorbidities and also by the gradual loss to follow-up of patients.
Late-onset vitiligo is not uncommon and tends to be of the focal vitiligo subtype. Nonsegmented vitiligo is more prevalent than segmental vitiligo. Combination therapy with topical medications and phototherapy is superior to monotherapy.
迟发性白癜风定义为临床发病年龄在50岁及以上，目前其特征仍不清楚。
本研究旨在描述迟发性白癜风患者的临床特征和治疗反应。
我们回顾性分析了2010年1月1日至2014年12月31日期间所有诊断为迟发性白癜风患者的病历。获得的信息包括患者人口统计学资料、白癜风特征和治疗反应。
在5年期间诊断为白癜风的3128例患者中，461例（14.7%）为迟发性疾病。该研究中女性（n = 260，56.4%）多于男性，平均发病年龄为59.4±7.4岁。大多数患者为中国人（n = 308，66.8%），45例（9.8%）患者伴有自身免疫性疾病。局限性白癜风定义为色素脱失斑的局限性存在，最为常见（n = 209，45.3%）。对359例患者的治疗反应进行了评估，其中216例接受单一疗法（外用乳膏：n = 210，97.2%；光疗：n = 6，2.8%），143例接受两种疗法。56例（15.6%）患者接受口服类固醇治疗。与单一疗法相比，接受外用乳膏和光疗联合治疗的患者临床反应更好（P < 0.001），其中56.6%（n = 81）的患者实现了良好的表皮色素再生，定义为色素沉着恢复至基线的>50%（单一疗法组为n = 66，30.6%）。光疗的选择（靶向、窄谱中波紫外线或补骨脂素+长波紫外线）对临床反应无显著影响（P = 0.774）。
本研究受其回顾性性质的限制，记录不规范导致无法确定疾病进展和相关代谢合并症，并且患者逐渐失访。
迟发性白癜风并不少见，倾向于局限性白癜风亚型。非节段性白癜风比节段性白癜风更常见。外用药物和光疗联合治疗优于单一疗法。
