Combination Treatment Modalities May be Ideal for Pediatric Patients With Vitiligo

Combination treatment modalities, including topical therapies and phototherapy, may be ideal approaches for pediatric vitiligo, according to a review study published in Dermatologic Therapy.

The researchers of this review study examined the most effective treatment options for pediatric vitiligo reported in recent literature. Studies identified in the review often reported effective results with topical corticosteroids, typically when applied daily for 2 or 3 months. These studies demonstrate topical corticosteroids could be used continuously or intermittently and either alone or combined with calcipotriene. Adverse effects associated with oral corticosteroids in children include a 6% to 10% weight gain, hyperglycemia, and infection that may lead to death.

Other studies report the use of topical calcineurin inhibitors as effective first-line treatments for pediatric vitiligo. These studies generally report the application of these therapies twice daily. Off-label drugs used for vitiligo include tacrolimus at 0.3% or 0.1% and pimecrolimus at 1%. Side effects associated with topical calcineurin inhibitors in children include irritation, erythema, pruritis, and burning sensations. Studies have yet to conclusively show that tacrolimus increases photocarcinogenicity, but there are some reports of hyperpigmentation associated with the use of this therapy.

Laser-assisted drug delivery of topical betamethasone has shown promise in some studies of pediatric vitiligo. Photochemotherapy with psoralens and ultraviolet A has also been shown to be broadly beneficial, but adverse effects such as pain and premature aging must be taken into consideration.

Oral psoralens and UVA are not advised for children less than 10 years of age. Likewise, narrow-band ultraviolet B (UVB) has increasingly become a first-choice option in children because of its ability to lead to repigmentation. This therapeutic modality also increases vitamin D levels and has anti-inflammatory properties. Stinging, phototoxicity, blistering, premature aging, and increased risk for skin cancer are side effects associated with UVB therapy.

Limitations of this study was the lack of a pooled meta-analysis to identify significant benefits of certain therapies over other therapies.

The investigators’ suggestion “for the treatment of this disease in children is to use combined treatment modalities while observing safety according to the patient’s age.”

Reference

Roohaninasab M, Mansouri P, Seirafianpour F, Naeini AJ, Goodarzi A. Therapeutic options and hot topics in vitiligo with special focus on pediatrics’ vitiligo: A comprehensive review study. Published online November 17, 2020. Dermatol Ther. doi:10.1111/dth.14550