Topical Calcineurin Inhibitors in the Treatment of Vitiligo

Vitiligo is the most common depigmenting disorder, with a prevalence of approximately 0.5% in the world population. Almost half of the patients with vitiligo present before 20 years of age. The two sexes are affected equally, and there are no apparent differences according to skin type or race.1,2 On histology, vitiligo is identified by the loss of epidermal melanocytes with absence of inflammation. Commonly used repigmentation therapies whose efficacy is supported by data from randomized controlled trials include ultraviolet light (for whole body or targeted lesions) and topical agents (corticosteroids and calcineurin inhibitors). Narrow-band ultraviolet B radiation (NB-UVB), which delivers peak emission at 311nm, is currently the preferred treatment for adults and children with vitiligo. Topical therapies may be effective in cases of localized disease. Combination therapy is often considered when there has been no response to phototherapy alone after three months or when the goal is to accelerate the response and reduce cumulative exposure to UV light.3 This chapter will review the literature on the topical use of pimecrolimus and tacrolimus in the treatment of vitiligo alone as well as when combined with other common therapies.