Introduction: Vitiligo remains a highly burdensome disease associated with significant autoimmune and psychosocial comorbidities. Although the therapeutic landscape has long been dominated by off-label therapy, new treatments are emerging. Limited guidance on how to safely and effectively utilize available therapies poses challenges for healthcare providers. Herein, we provide generally accepted principles, consensus recommendations, and a treatment algorithm for the management of vitiligo, as developed by a panel of ten Canadian dermatologists with expertise in managing vitiligo.

Methods: The three-phase process consisted of identifying themes and research questions; conducting a systematic literature review; and discussing/voting on generally accepted principles, consensus statements, and a treatment algorithm using an iterative consensus process.

Results: Experts agreed to 27 generally accepted principles, ten consensus statements, and a treatment algorithm. Education about vitiligo pathogenesis and repigmentation biology can help patients, caregivers, and healthcare providers set realistic expectations for treatment. Treatment should focus on repigmentation or stabilizing progression, rather than on depigmentation. Topical therapies include topical corticosteroids, topical calcineurin inhibitors, and the topical Janus kinase inhibitor ruxolitinib cream. Phototherapy, such as narrow-band ultraviolet B and excimer laser/lamp, can be used as monotherapy or in combination with other treatments. Off-label systemic therapies may be appropriate for patients with unstable or rapidly progressing disease. Surgical therapy may be suitable for patients with localized or stable recalcitrant disease. Maintenance therapy may help mitigate the risk of disease relapse.

Conclusion: Improved clarity around the benefits, risks, and limitations of available therapies has supported the development of robust guidelines and a treatment algorithm for vitiligo. Disease stabilization and repigmentation are goals that can largely be achieved, particularly when patients share a mutual understanding of vitiligo and its treatment options. A Graphical Abstract is available for this article.

导言： 白癜风仍然是一种负担沉重的疾病，伴有严重的自身免疫和社会心理并发症。虽然长期以来，治疗领域一直以标签外治疗为主，但新疗法也在不断涌现。如何安全有效地利用现有疗法的指导有限，这给医疗服务提供者带来了挑战。在此，我们提供了公认的原则、共识建议和治疗算法，这些原则、建议和算法是由加拿大十位擅长治疗白癜风的皮肤科医生组成的专家小组制定的。

方法： 该过程分为三个阶段：确定主题和研究问题；进行系统的文献综述；使用迭代共识过程对公认原则、共识声明和治疗算法进行讨论/投票。

结果： 专家们就27项普遍接受的原则、10项共识声明和一种治疗算法达成了一致。关于白癜风发病机制和再色素沉着生物学的教育可以帮助患者、护理人员和医疗服务提供者对治疗设定切合实际的期望。治疗的重点应放在再色素沉着或稳定病情发展上，而不是脱色上。外用疗法包括外用皮质类固醇激素、外用钙神经蛋白抑制剂和外用Janus激酶抑制剂ruxolitinib乳膏。光疗，如窄波段紫外线 B 和准分子激光/灯，可作为单一疗法或与其他疗法联合使用。标示外系统疗法可能适合病情不稳定或进展迅速的患者。手术疗法可能适合局部或病情稳定的顽固患者。维持治疗有助于降低疾病复发的风险。

结论：对现有疗法的益处、风险和局限性的进一步明确，有助于制定强有力的指南和白癜风治疗算法。疾病稳定和色素恢复是可以实现的目标，尤其是当患者对白癜风及其治疗方案有了共同的理解时。本文有图文摘要。