Evaluation and treatment of vitiligo

Abstract

This thesis considers several aspects of vitiligo; it investigates (i) provoking factors of vitiligo, (ii) the prevalence of thyroid disease, (iii) the efficacy and safety of autologous punch- and cell suspension grafting and (iv) measurement properties of outcome measures for vitiligo. Chapter 2.1 is a retrospective cohort study and gives insight in the patient reported provoking factors of vitiligo including contact with chemicals. In Chapter 2.2 the role of 4-TBP as provoking factor for vitiligo was analysed in a patient with chemically induced contact vitiligo. In Chapter 3.1 current evidence of the prevalence of thyroid diseases in vitiligo is summarised and critically appraised in a systematic review. We found an increased prevalence and an increased risk of (autoimmune) thyroid disease in patients with vitiligo patients compared to non-vitiligo. In Chapter 4.1 the efficacy and safety of different punch depths and punch sizes in autologous punch grafting is compared in an observer blinded randomised controlled trial. We show that 1.5 mm superficial grafts are most beneficial and could be recommended to use in autologous punch grafting in patients with stable vitiligo and piebaldism. Chapter 4.2 determines the efficacy and safety of cellsuspension grafting with a cell harvesting divice (CST-CHD) in vitiligo and piebaldism. The CST-CHD method is found to be an effective, safe and relatively simple technique for CST that allows for the complete transplantation in the operation theatre. Chapter 5 presents the results of a systematic review on outcome measures for vitiligo using the COSMIN checklist. We found that current evidence is insufficient owing to a low number of studies with a poor methodological quality and unclear clinical relevance