Repigmentation of pretibial vitiligo with calcineurin inhibitors under occlusion.
Treatment of vitiligo is a challenge, especially in children. Recently, topical calcineurin inhibitors have been introduced in the management of vitiligo, but significant repigmentation is not achieved except on the face. Large pretibial lesions of a 15-year-old female with progressive vitiligo were treated twice daily over six months with 0.1% tacrolimus ointment on the right and 1% pimecrolimus cream on the left side without effect. Additional overnight occlusion with polyurethane and hydrocolloid foils during the following 18 months led to substantial repigmentation on both sides (tacrolimus-treated side, 88% repigmented area; pimecrolimus-treated side, 73%). Tacrolimus serum levels measured at four different time points did not exceed 1.8 ng/ml. This case report on a direct comparison of topical tacrolimus and pimecrolimus in vitiligo shows that on the shins considerable improvement could be induced with both agents only by additional long-term occlusion and that tacrolimus was somewhat more effective than pimecrolimus.
Clinic and Policlinic for Dermatology, Venerology, and Allergology, University of Würzburg, Germany. anke.hartmann@derma.imed.uni-erlangen.de
Anke
A
Hartmann
Eva-Bettina
EB
Bröcker
Henning
H
Hamm
D000287:Administration, Topical; D000293:Adolescent; D065095:Calcineurin Inhibitors; D003879:Dermatologic Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007868:Leg Dermatoses / Q000188:drug therapy* / Q000473:pathology; D009779:Occlusive Dressings; D012074:Remission Induction; D012880:Skin Pigmentation / Q000187:drug effects; D016559:Tacrolimus / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D013977:Tibia / Q000473:pathology; D016896:Treatment Outcome; D014820:Vitiligo / Q000188:drug therapy* / Q000473:pathology
D065095:Calcineurin Inhibitors; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; C117268:pimecrolimus; D016559:Tacrolimus