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A systematic review of interventions for idiopathic guttate hypomelanosis

Background: Idiopathic guttate hypomelanosis (IGH) is a common benign leucoderma, the incidence of which increases with age. Treatment is often sought for cosmetic reasons. However, there is a paucity of information regarding effective treatments for this condition.

Objectives: To evaluate and compile the effects of interventions for IGH.

Methods: MEDLINE (through PubMed), Web of Science and Scopus databases were searched for articles reporting interventions for IGH, from inception up to November 2023. Reference lists of identified articles were searched for additional articles. Eligibility criteria included human randomized controlled trials (RCTs), clinical studies (non-RCTs) and case series studies (n > 5 patients) of topical treatments, light-based or energy-based devices and procedural interventions for IGH. Repigmentation was the primary outcome of interest. At least two reviewers were involved in article screening, selection, data extraction and quality assessment.

Results: Our search returned 522 articles, of which 20 met the eligibility criteria: 9 randomized studies and 11 quasi-experimental studies. The number of patients per study ranged from 6 to 240, and the maximum number of macules included was 2129. Thirteen studies used a quartile grading score to report outcomes. Half of the randomized studies had a high risk of bias, and the outcome measures were heterogeneous across studies. The treatment modalities were well-tolerated.

Conclusions: A wide range of interventions are effective in treating IGH. Most treatment modalities involve some form of therapeutic wounding. However, study design and methodology limitations must be considered for each intervention that has been evaluated. There is a paucity of large RCTs with standardized outcome measures and follow-up data regarding the longevity of repigmentation in patients with IGH.

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