Diagnosis and Management of Vogt-Koyanagi-Harada Syndrome

Clinical Diagnosis and Treatment

The British Association of Dermatologists recommends against using oral dexamethasone for isolated vitiligo due to unacceptable side-effects, but systemic corticosteroids are the standard of care for VKH syndrome due to multi-organ involvement and risk of permanent vision and hearing loss 3, 4
Autoimmune thyroid disease occurs in approximately 34% of vitiligo patients, and thyroid function tests should be performed as part of the diagnostic workup 1, 2

Potent topical corticosteroids, such as clobetasol propionate 0.05% or betamethasone valerate 0.1%, can achieve 15-25% repigmentation in approximately 43% of patients when applied twice daily for a maximum of 2 months 2
Calcineurin inhibitors, such as tacrolimus 0.1% or pimecrolimus 1%, provide comparable efficacy with a superior safety profile, particularly for facial involvement 2, 5
Narrowband UVB is preferred over PUVA for widespread vitiligo due to greater efficacy and safety, with a maximum of 200 treatments for skin types I-III 3, 5

Serial photographs should be taken every 2-3 months to objectively document disease progression or response, and psychological interventions should be offered as vitiligo can be cosmetically disfiguring and stigmatizing 2, 6
Patients with VKH syndrome should be screened for other autoimmune conditions, given the high association with autoimmune thyroid disease 1, 2