Key Takeaways
Adding topical tacrolimus to NB-UVB is associated with higher facial response rates and earlier perifollicular repigmentation in many trials.
Safety is generally favorable; combination increases local irritation/erythema but avoids psoralen-related effects.
Greatest absolute gains seen on face/neck ; acral sites remain challenging.
Contents
Abstract Trial Design Participants Interventions & Dosing Endpoints Results Safety Subgroup Findings Limitations References Related Articles
Abstract
This article summarizes randomized controlled data comparing NB-UVB plus topical tacrolimus versus NB-UVB alone in nonsegmental vitiligo. We outline design elements, dosing protocols, efficacy on facial and total VASI endpoints, safety profiles, and subgroup trends relevant to clinical decision-making.
Trial Design
Table 1. Study design and conduct.
Parameter
NB-UVB + Tacrolimus
NB-UVB Alone
Design
Randomized, parallel-group; assessor-blinded photography
Duration
24–26 weeks treatment; 12–24 weeks follow-up
Centers
Dermatology phototherapy clinics (multicenter)
Randomization
1:1 with site stratification
Concomitants
Emollients allowed; no other immunomodulators
Participants
Table 2. Key inclusion/exclusion and baseline features.
Category
Criteria
Inclusion
Age ≥12; nonsegmental vitiligo; F-VASI ≥1.0 or T-VASI ≥3.0; stable or active
Exclusion
Excessive sun exposure; recent systemic immunosuppressants; photosensitivity disorders
Baseline notes
Phototypes II–V; facial involvement frequent; acral areas in subset
Interventions & Dosing
Table 3. Regimens.
Arm
NB-UVB regimen
Tacrolimus
Notes
Combination
2–3×/week; start 200–300 mJ/cm²; +10–20% per session to mild erythema
0.1% ointment, thin layer BID on target lesions (esp. face/neck)
Hold tacrolimus on treatment day in sensitive skin if irritation
Monotherapy
Same NB-UVB schedule and escalation
—
Emollients as needed
Endpoints
Primary: Change in F-VASI at week 24 or proportion achieving F-VASI50.Secondary: T-VASI change; time to first visible repigmentation; patient/physician global assessment; durability at follow-up.Exploratory: Perifollicular island count; lesion border softening; QoL change (DLQI or VitiQoL).
Results
Table 4. Efficacy outcomes (illustrative structure; populate with study data).
Outcome
NB-UVB + Tacrolimus
NB-UVB Alone
Between-group
F-VASI % change (week 24)
Greater reduction
Reduction
Favours combination
F-VASI50 responders
Higher proportion
Lower proportion
Favours combination
T-VASI % change
Meaningful reduction
Meaningful reduction
Difference varies by site
Time to visible response
Earlier
Later
Favours combination
Durability (post-stop)
Good with maintenance
Good with maintenance
Comparable
Safety
Table 5. Treatment-emergent adverse events (≥5%).
Event
NB-UVB + Tacrolimus
NB-UVB Alone
Comments
Erythema
Common, transient
Common, transient
Manage by dose hold/reduction
Burning/tingling at application site
More frequent
Less frequent
Usually mild; improve with spacing applications
Pruritus/dryness
Occasional
Occasional
Emollients; short topical steroid if needed
Subgroup Findings
Face/neck : largest absolute improvement with combination.Acral : limited benefit in both arms; consider surgical options if stable.Phototype : higher cosmetic gains in III–V; dosing must be individualized.Early responders : week 4–8 perifollicular islands predict stronger endpoints.
Limitations
Heterogeneity in tacrolimus potency/frequency, NB-UVB dose algorithms, and endpoint definitions limits pooling; follow-up beyond 6–12 months is sparse.
References
Randomized and comparative studies of NB-UVB plus topical tacrolimus versus NB-UVB alone in vitiligo.
Phototherapy protocols for NB-UVB in vitiligo and guidance on topical calcineurin inhibitor use.
Reviews on facial repigmentation strategies and maintenance approaches.