title: Treatment of Childhood Vitiligo Using Tacrolimus Ointment with Narrowband Ultraviolet B Phototherapy.
abstract: OBJECTIVE
  A combination of narrowband ultraviolet B (NBUVB) phototherapy plus topical tacrolimus has been used in adult vitiligo but has not yet been explored in children. We therefore sought to highlight the efficacy of this synergistic combination in childhood vitiligo. The objective was to study the clinical efficacy and safety of a combination of NBUVB with topical tacrolimus ointment 0.03% in childhood vitiligo.
  
  
  METHODS
  In this open-label study, 20 children, 4 to 14 years of age, with symmetrical vitiligo lesions were enrolled for 24 weeks. All were instructed to apply tacrolimus ointment 0.03% on a target patch on the left side of the body twice daily and no topical on a target patch on the right side. The whole body was irradiated with NBUVB three times per week. All patients were examined and the same dermatologist photographed lesions to assess for repigmentation at 4-week intervals. Response was noted as the percentage of repigmentation (none, 0%; poor, 1-25%; moderate, 26-50%; good, 51-75%; excellent, >75%).
  
  
  RESULTS
  Our study found a statistically significant difference in the mean percentage of repigmentation at 4 and 6 months between combination therapy and NBUVB monotherapy. The mean cumulative dose and average number of exposures for the first clinically visible response were significantly lower with combination therapy. No serious adverse events were noted during the study period.
  
  
  CONCLUSIONS
  Our preliminary data suggest that a combination of NBUVB phototherapy with topical tacrolimus is a highly effective and promising therapeutic option for vitiligo in children, whose treatment options are very limited, but long-term studies are needed to evaluate the future risk of malignancy.
authors.affiliation: Department of Dermatology, Venereolgy and Leprology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors.forename: Surabhi
authors.initials: S
authors.lastname: Dayal
authors.affiliation: Department of Dermatology, Venereolgy and Leprology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors.forename: Priyadarshini
authors.initials: P
authors.lastname: Sahu
authors.affiliation: Skin Clinic, Kurukshetra, Haryana, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009824:Ointments; D011446:Prospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome; D014467:Ultraviolet Therapy; D014820:Vitiligo / Q000188:drug therapy*
chemical_list: D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus