Facial/neck lesions show the highest response rates to tacrolimus 0.1%, often with early perifollicular islands of repigmentation.
Trunk/extremities (non-acral) respond moderately; acral sites remain challenging and benefit from combinations (NB-UVB/excimer).
In children, tacrolimus is favored on the face and intertriginous areas due to a steroid-sparing safety profile.
Common local effects are mild burning/tingling; no skin atrophy is expected compared with potent topical steroids.
Abstract
This article synthesizes clinical evidence on tacrolimus 0.1% ointment for vitiligo, emphasizing dosing practices, efficacy patterns across facial, trunk, and acral zones, pediatric versus adult outcomes, safety, and integration with phototherapy.
Dosing & Application
Table 1. Practical dosing parameters for tacrolimus 0.1%.
Parameter
Typical approach
Notes
Frequency
BID thin layer
Reduce to QD for maintenance or if irritation
Duration
12–24 weeks initial course
Extend if ongoing repigmentation; reassess at weeks 8–12
Anatomic adjustments
Preferred on face/neck/flexures
Use as steroid-sparing in sensitive areas
With phototherapy
Apply after light session
Hold on treatment day if irritation in sensitive skin
Evidence Overview
Table 2. Representative studies of tacrolimus 0.1% in vitiligo (structure for site data entry).
Study
Population (n)
Sites treated
Regimen
Key outcomes
Adult facial vitiligo (prospective)
Adults (n≈40–60)
Face/neck
0.1% BID × 24 wks
High F-VASI response; early perifollicular islands
Pediatric mixed sites (observational/RCT)
Children (n≈30–80)
Face & non-facial
0.03–0.1% BID
Superior facial response; good tolerability
Adult mixed sites (split-body)
Adults (n≈20–40)
Face/trunk vs acral
0.1% BID
Trunk responds; acral limited without phototherapy
Efficacy by Anatomic Zone
Table 3. Typical response patterns by zone.
Zone
Response profile
Practical notes
Face/neck
Highest response; earlier islands
Preferred first-line topical; track F-VASI
Trunk/non-acral extremities
Moderate response
Consider adjunct NB-UVB if slow
Acral (hands/feet)
Poor response to monotherapy
Add excimer/NB-UVB; consider surgery if stable
Pediatric vs Adult Outcomes
Table 4. Age-group considerations.
Aspect
Children
Adults
Tolerability
Generally excellent; transient sting common
Good; counsel on adherence
Preferred sites
Face/neck, flexures
Face/neck; non-acral trunk
Adjuncts
NB-UVB/excimer for broader disease
Same; consider maintenance schedules
Safety
Table 5. Common local adverse effects (≥5%).
Event
Typical course
Management
Burning/tingling
Mild, transient at initiation
Reduce to QD; apply after emollient
Erythema/irritation
Occasional
Short pause; re-titrate
Folliculitis (rare)
Localized
Spacing doses; brief rest
No cutaneous atrophy is expected with calcineurin inhibitors, supporting long-term use in sensitive areas compared with potent steroids.
Combination Strategies
NB-UVB + tacrolimus for face/neck accelerates repigmentation versus NB-UVB alone.
Excimer 308 nm + tacrolimus for focal lesions, especially acral margins.
Maintenance: taper to QD or alternate-day once plateau reached.
Limitations
Heterogeneity across studies (potency 0.03–0.1%, frequency, endpoints) and limited long-term relapse data; acral outcomes remain modest without adjunct therapy.
References
Randomized and observational studies of tacrolimus 0.1% in facial and non-facial vitiligo (adult and pediatric cohorts).
Comparative data on calcineurin inhibitors vs topical steroids and as adjuncts to NB-UVB/excimer.
Guidance statements on steroid-sparing therapy in cosmetically sensitive areas.