Smith Mary Patricia, Ly Karen, Thibodeaux Quinn, Bhutani Tina, Nakamura Mio
Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.
Department of Dermatology, University of Michigan, Ann Arbor, MI, USA.
Clin Cosmet Investig Dermatol. 2019 Jun 28;12:451-459. doi: 10.2147/CCID.S185798. eCollection 2019.
Vitiligo is a chronic autoimmune condition involving selective dysfunction and destruction of melanocytes in the skin, hair, or both. The typical presentation is well-demarcated depigmented skin patches. Given vitiligo is the most common cause of depigmentation worldwide and early disease responds best to treatment, prompt diagnosis and proactive management of vitiligo are critical. While a wide variety of treatments has demonstrated variable effectiveness in treating vitiligo, phototherapy remains standard of care because of its proven efficacy and favorable side effect profile. However, many patients with vitiligo are unable to access affordable, consistent, or convenient phototherapy. To address these issues, home-based phototherapy has emerged as a patient-centered alternative. The purpose of this review is to discuss management of vitiligo with a specific focus on access to home-based phototherapy (HBPT) for patients with this condition. Key challenges to HBPT include misperceptions around safety and efficacy, inadequate physician education and training, insurance and financial barriers, and appropriate patient selection. Solutions to these challenges are presented, such as approaches to improve physician education and increasing the evidence surrounding the effectiveness and safety of this treatment for vitiligo. In addition, various practical considerations are discussed to guide dermatologists on how to approach HBPT as a treatment option for patients with vitiligo.
白癜风是一种慢性自身免疫性疾病，涉及皮肤、毛发或两者中黑素细胞的选择性功能障碍和破坏。典型表现为边界清晰的色素脱失斑。鉴于白癜风是全球色素脱失最常见的原因，且早期疾病对治疗反应最佳，因此白癜风的及时诊断和积极管理至关重要。虽然多种治疗方法在治疗白癜风方面已显示出不同程度的疗效，但光疗因其已证实的疗效和良好的副作用特征，仍然是标准的治疗方法。然而，许多白癜风患者无法获得负担得起、持续或便捷的光疗。为了解决这些问题，家庭光疗已成为一种以患者为中心的替代方案。本综述的目的是讨论白癜风的管理，特别关注为患有这种疾病的患者提供家庭光疗（HBPT）的情况。HBPT的主要挑战包括对安全性和疗效的误解、医生教育和培训不足、保险和经济障碍以及合适的患者选择。本文提出了应对这些挑战的解决方案，例如改善医生教育的方法以及增加关于这种白癜风治疗方法有效性和安全性的证据。此外，还讨论了各种实际考虑因素，以指导皮肤科医生如何将HBPT作为白癜风患者的一种治疗选择。
