Pediatric Vitiligo: Topical Corticosteroid vs. Calcineurin Inhibitor

Abstract

Introduction: Vitiligo treatment in children requires high safety profiles. This review compares topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI) for repigmentation in pediatric patients. Methods: Ten RCTs and cohort studies (n=647, age 2–16 years). Outcome: ≥75% repigmentation at 6 months. Safety: skin atrophy and burning sensation. Results: TCS achieved ≥75% repigmentation in 47% of face lesions and 22% of non-facial lesions. TCI had similar efficacy (44% facial, 20% non-facial, p=ns). TCI caused transient burning (31% vs 8% for TCS). No skin atrophy with TCI. Discussion: TCI are non-atrophogenic and suitable for sensitive areas (eyelids, genitals). Lack of head-to-head studies with newer JAK inhibitors is a limitation. Conclusions: TCI are equivalent to TCS for facial vitiligo in children and safer for long-term use.