What is the diagnosis and treatment for vitiligo of the scrotum?

From the Guidelines

Vitiligo of the scrotum should be treated with split-skin grafting, as it has been shown to be the most effective and safest technique, with excellent repigmentation results in 83% of patients. The diagnosis of vitiligo is typically made based on clinical presentation, with characteristics such as poor color match, cobblestone appearance, and periorificial distribution 1.

Treatment Options

When considering treatment options for vitiligo of the scrotum, several factors should be taken into account, including the extent of the disease, the patient's overall health, and the potential risks and benefits of each treatment. Some treatment options include:

• Topical corticosteroids, such as betamethasone 0.1% applied once or twice daily for 2-3 months
• Calcineurin inhibitors, such as tacrolimus 0.1% ointment applied twice daily for 3-6 months
• Phototherapy treatments, such as narrowband UVB therapy administered 2-3 times weekly for several months
• Split-skin grafting, which has been shown to be the most effective and safest technique, with excellent repigmentation results in 83% of patients 1

Considerations

It's essential to note that the scrotal area often responds better to treatment than other body sites due to its thin skin, allowing better medication penetration. However, treatment requires patience, as repigmentation typically takes months to occur, and maintenance therapy may be necessary to prevent recurrence 1. Regular skin examinations are crucial, as vitiligo patients have a slightly increased risk of other autoimmune conditions. The psychological impact of genital vitiligo should not be overlooked, and counseling may be beneficial alongside medical treatment.

Evidence-Based Recommendation

The recommendation for split-skin grafting is based on the study by Khandpur et al., which compared mini-punch grafting with split-skin grafting and found that 83% of patients who received split-skin grafts had excellent repigmentation results 1. This study provides the highest quality evidence for the treatment of vitiligo, and its findings should be prioritized when making treatment decisions.

From the Research

Diagnosis of Vitiligo of the Scrotum

• The diagnosis of vitiligo of the scrotum is based on the presence of characteristic white, hypopigmented macules and patches on the scrotum 2.
• The disease can cause a significant psychological and emotional burden on affected individuals and their families 3.

Treatment Options for Vitiligo of the Scrotum

• Phototherapy, including UVB-targeted phototherapy, is a common treatment modality for vitiligo, with narrowband UVB (NB-UVB) considered the safest and most effective alternative 4, 5, 3.
• Topical corticosteroids, such as fluocinolone acetonide and clobetasol propionate, can be used alone or in combination with levamisole to control disease activity and induce repigmentation 6.
• New therapeutic approaches, including topical ruxolitinib and WNT agonists, are being developed and may offer promising treatment options for vitiligo, including genital vitiligo 2.
• The choice of treatment should be individualized based on patient and disease characteristics, and combination therapies may be used to achieve optimal results 3.

Efficacy of Treatment Options

• UVB-targeted phototherapy has been shown to be effective in inducing repigmentation in vitiligo lesions, with an average repigmentation of 31.5% on the genitalia 4.
• Levamisole has been found to be effective in controlling disease activity and inducing repigmentation in patients with limited and slow-spreading vitiligo 6.
• Topical ruxolitinib has shown promising results in inducing repigmentation, although its efficacy in genital vitiligo remains to be assessed 2.