title: Topical tacrolimus is more effective for treatment of vitiligo in patients of skin of color.
abstract: BACKGROUND
  Vitiligo vulgaris is a chronic autoimmune depigmenting disorder affecting individuals of all skin colors. Lesions are commonly noted in the periorificial face and over the upper and lower extremities in areas of friction. Although there have been many published reports of successful therapies for vitiligo, few have assessed differential response based on skin color.
  
  
  OBJECTIVE
  To determine if topical tacrolimus is more effective at treating vitiligo in individuals of color.
  
  
  METHODS
  An IRB-approved chart review of patients with a diagnosis of vitiligo was conducted including patients seen between May 2001 and April 2006. Patients with vitiligo were treated with tacrolimus 0.03% for children ages 2-15 years of age and tacrolimus 0.1% ointment for individuals 16 years of age or older, applied twice-daily to all hypopigmented or depigmented lesions. A review of clinical features, Fitzpatrick skin type and response to topical tacrolimus were recorded.
  
  
  RESULTS
  Topical tacrolimus was effective in all Fitzpatrick skin types, with superior efficacy on body lesions in individuals of Fitzpatrick types 3-4 (Fisher exact test, P=0.03). Further, individuals with Fitzpatrick type 3-4 skin had shorter interval to greater than 75 percent improvement of lesions on the body (Kaplan-Meier Log-rank, P=0.03) and head and neck (P=0.016).
  
  
  CONCLUSIONS
  Topical tacrolimus is an effective treatment for vitiligo irrespective of skin tone, with greatest benefit in Fitzpatrick type 3-4 skin. Repigmentation of lesions on the head and neck is superior to repigmentation of the body and extremities in all racial subgroups.
authors.affiliation: St. Luke's-Roosevelt Hospital and Beth Israel Medical Center, New York, NY 10025, USA. nsilverberg@juno.com
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Silverberg
authors.forename: Nanette B
authors.initials: NB
authors.lastname: Silverberg
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009824:Ointments; D044469:Racial Groups; D012189:Retrospective Studies; D012880:Skin Pigmentation; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014820:Vitiligo / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus