Vitiligo can be devastating psychologically and in all ages it can be occurred. Currently there are two foundations of therapies that are phototherapy and topical steroids in combination or alone. These types of treatments are limited by efficiency data and lack of safety and by the possible side effects as well.

Tacrolimus treatment has been reviewed on 57 pediatric vitiligo patients (widespread, 58%; acrofacial, 5%; segmental, 37%; range of age, 4 to 16 years; white 44%, 28% Latino, black 16%, 6% East Indian, Middle Eastern 3% and Asian 3%) by the investigators. Improvement produced by those 43 patients who had gone through some other methods of treatments like phototherapy (sunlight or other various PUVA) and topical steroids.

Tacrolimus ointment has been given to all patients for minimum 3 months (26 patients, 0.03% dilution; 0.1% on 31 patients). Response has been visually evaluated by the physicians during their routine visits to the clinic. Pre and Post medications photographs were taken of almost half of the patients.

At least fractional response has been produced by Tacrolimus in 84%. Response rate, on the neck and head it was 89% and on the chest and edges of the body it was 63% and statistically it did not differ by the concentration. Repigmentation of eyelid was complete and most rapidly. Its responses also differs in all seasons like 100% response has been given by the patients who started therapy in summer, in spring responded 67%, in fall 80% and in winter response rate was 61%. And the best response rate had been received from the facial segmental vitiligo.

Comments: Although this study was demonstrative and unblended but the results of tacrolimus ointment show that this method is useful for vitiligo in children and especially if it is on neck or head. It is also appealing especially for facial sites and periocular where the use of topical steroids for long term is not desirable. Atopic dermatitis therapy trials have shown that tacrolimus is safe for children but still we need controlled studies and potential to find out its efficiency in childhood vitiligo.

Mary Wu Chang, MD

Published on 15th February 2005 in Journal Watch Dermatology