Management overview

Before discussing management with the patient, a thorough assessment is needed. An assessment form has been produced by the Vitiligo European task force (VETF) (see Part 1.4) which summarizes major history taking and examination items. It has been recently updated [http://content.nejm.org/cgi/content/full/ 360/2/160/DC1] [1]. Skin color and ability to tan (phototype), disease duration, and disease activity are important decision management items, as well as the patient psychological profile and ability of coping with the disease. In some nonsegmental vitiligo (NSV) patients, an acceleration phase occurs with a rapid disease progression in a few weeks/months which needs a more urgent intervention, usually minipulse therapy (Chap. 3.5.1). Other useful clinical management items include previous episodes of repigmentation; type, duration, and usefulness of previous treatments. The analysis of the Koebner phenomenon (Sect. 2.2.2.1) is of particular interest for prevention, and needs a review with the patients according their daily habits (hygiene, clothing) and occupations. We use a slide projection in our clinic to show some striking examples. A question about vitiligo on genitals is included because it causes a strong embarass-ment to patients, as first reported to us by the patient's support groups. A global quality of life assessement is recommended (how does vitiligo currently affects your everyday life) assessed on a visual analog scale, which is a coarse but useful indicator of coping with the disease (Part 3.13). This is important because we know that the patient's personality and perceived severity of the disease are predictors of quality of life impairment and will guide our management options [2].