Face/neck consistently show the best repigmentation with tacrolimus 0.1%; early perifollicular islands predict response.
Acral (hands/feet) and longstanding lesions are comparatively refractory; consider adjunct NB-UVB or excimer 308 nm.
Useful as a steroid-sparing first-line agent on cosmetically sensitive skin (eyelids, periocular/perioral, genital).
Favorable safety for adults and children; most AEs are mild/transient burning or erythema without atrophy.
Abstract
Topical tacrolimus 0.1% is an established steroid-sparing therapy for vitiligo, with strongest efficacy on face and neck. This article synthesizes zone-specific outcomes, dosing practices, pediatric data, combination with light therapy, and safety signals.
Evidence by Anatomic Zone
Table 1. Typical response gradient by site.
Zone
Response
Notes
Face/neck
High
Early perifollicular islands; good F-VASI change
Trunk/limbs (non-acral)
Moderate
Slower than face; add NB-UVB if plateau
Acral (hands/feet)
Low
Combine with excimer or surgery when stable
Dosing & Practical Use
Table 2. Suggested regimen.
Aspect
Recommendation
Comment
Frequency
BID thin layer to lesions
Reduce to QD if irritation
Sequence
After emollient; after light on treatment days
Limits stinging
Duration
Assess at 8–12 weeks; continue if improving
Maintenance taper when plateau
Pediatric Considerations
Preferred on eyelids/periorificial areas to avoid steroid atrophy.
Adherence and gentle skincare (emollients, sun protection) enhance tolerability.
Monitor for transient burning; step-down to QD or alternate-day as needed.
Combination Strategies
NB-UVB 311 nm (2–3×/week) accelerates and deepens response versus monotherapy.
Excimer 308 nm for focal, resistant edges or acral margins.
Consider maintenance with tacrolimus after successful phototherapy to reduce relapse.
Safety
Table 3. Common adverse effects.
Event
Pattern
Management
Burning/tingling
Mild, transient at initiation
QD for 1–2 weeks; emollients
Erythema/irritation
Occasional
Brief pause; re-titrate
Folliculitis
Rare
Spacing doses; short rest
No cutaneous atrophy/telangiectasia expected with calcineurin inhibitors; suitable for long-term use on face/neck.
Outcome Tables (framework)
Table 4. Efficacy readouts to populate from studies.
Outcome
Tacrolimus 0.1%
Comparator
Interpretation
F-VASI % change (12–24 wks)
—
Vehicle/observation
Favours tacrolimus on face/neck
F-VASI50/75 responders
—
—
Higher proportion on face
Acral response
—
—
Limited; needs combination
Limitations
Heterogeneous endpoints and small RCTs/split-face designs; limited long-term off-drug durability data; acral outcomes remain suboptimal.
References
Split-face/RCT evidence for tacrolimus 0.1% in facial/periorificial vitiligo.
Cohort and pediatric series detailing zone-specific responses and safety.
Combination studies with NB-UVB and excimer for refractory sites.