Key points

• A meta-analysis of RCTs has found that psoralen plus sunlight and topical class 3 corticosteroids are effective when compared with placebo for treating generalised and localised vitiligo respectively. Photochemotherapy requires careful dosage and close monitoring for acute toxicity and long-term carcinogenic effects. Two RCTs have found that concurrent topical calcipotriol potentiates the efficacy of PUVA.

• Mainly case series have shown that PUVA and UVB are effective. Long-term side-effects of UVB are unknown.

• We found limited evidence (case series only) on the effectiveness of surgical treatments for selected patients and on the effectiveness of depigmentation therapy for vitiligo universalis.

• We found no evidence of efficacy for phenylalanine, topical or oral khellin and melagenine.

• We found treatments to have been evaluated mainly in the short term, with very few comparative trials. The maintenance value of therapies, and the assessment of patients' preferences, satisfaction and quality of life have not yet been adequately addressed. Patient compliance was seldom reported in the studies.

• Only a few studies reporting negative results with a therapy were found.

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