Key Takeaways
- Highest efficacy on face/neck with early perifollicular islands; moderate on trunk/limbs; limited on acral sites without phototherapy add-ons.
- Ideal as a steroid-sparing agent for sensitive zones and pediatrics; can be used long-term with favorable safety.
- NB-UVB (311 nm) or excimer 308 nm combinations increase speed and magnitude of repigmentation.
Abstract
Tacrolimus 0.1% ointment is a face- and fold-friendly calcineurin inhibitor used in vitiligo. Across RCTs/series, facial lesions respond best, trunk shows steady but slower gains, and acral sites remain challenging without adjunct phototherapy. We summarize zone-based outcomes, dosing, combinations, pediatric considerations, and safety.
Dosing & Schedules
- Apply a thin layer BID to depigmented patches; avoid occlusion.
- Continue for 12–24 weeks before judging plateau; extend if improving.
- Maintenance: reduce to once daily or weekend therapy on relapse-prone sites.
Efficacy by Zone
| Zone | Expected response | Notes |
|---|---|---|
| Face/neck | High | Early perifollicular islands; strong F-VASI change |
| Trunk/limbs (non-acral) | Moderate | Slower consolidation; benefit with NB-UVB |
| Acral (hands/feet) | Low–moderate | Add excimer/NB-UVB; manage expectations |
Combinations with Light Therapy
- NB-UVB 311 nm 2–3×/week enhances face and body outcomes.
- Excimer 308 nm targets rims/acral margins and speeds islands.
- Intermittent topical corticosteroids can be pulsed on non-facial zones, with tacrolimus on face/neck.
Pediatric Use
- Preferred on face/folds to avoid steroid atrophy; educate on fingertip-unit dosing.
- Combine with NB-UVB when broader disease or slow body response.
- Monitor tolerance; stinging is usually transient.
Safety & Tolerability
| AE | Pattern | Mitigation |
|---|---|---|
| Transient burning/erythema | Early treatment | Apply after moisturizer; reduce frequency briefly |
| Folliculitis/acneiform | Face | Non-comedogenic emollients; adjust use |
No skin atrophy/telangiectasia expected; avoid mucosal/occluded application.
Outcome Tables (framework)
| Outcome | Tacrolimus | Comparator | Interpretation |
|---|---|---|---|
| F-VASI % change (12–24 wks) | — | Vehicle/steroid | Strongest on face |
| F-VASI50/75 responders | — | — | Improves with NB-UVB |
| Acral responder rate | — | — | Lower; needs combination |
| Relapse after stop | — | — | Maintenance advisable |
Limitations
Heterogeneity in endpoints and regimens across RCTs/series; limited long-term off-drug durability data, particularly for acral sites.
References (framework)
- Randomized and observational studies of tacrolimus 0.1% in facial and non-facial vitiligo.
- Combination studies with NB-UVB and excimer 308 nm.
- Guidelines on calcineurin inhibitor use in pediatric and sensitive sites.