Tacrolimus 0.1% in Vitiligo: Efficacy by Site (Face/Neck vs Trunk vs Acral)

Key Takeaways

Face/neck respond best to tacrolimus 0.1%, with earlier perifollicular islands and higher chances of achieving F-VASI50/75 when combined with light.
Trunk/limbs respond moderately; sustained use and light combinations improve outcomes.
Acral (hands/feet) respond slowly and require excimer 308 nm or NB-UVB add-ons and friction control.
Safety: no skin atrophy; transient stinging/burning common initially; suitable for face/folds and pediatric use.

Why Tacrolimus Helps in Vitiligo

Tacrolimus 0.1% is a topical calcineurin inhibitor that blunts T-cell–driven inflammation implicated in melanocyte loss. On face/neck, dense follicular units provide melanocyte reservoirs; tacrolimus supports repigmentation by reducing rim activity and enabling perifollicular islands to coalesce.

Dosing & Practical Use

Application: thin layer BID to affected areas; once-daily may be considered for maintenance after response.
Duration: reassess at 8–12 weeks; continue 24–36 weeks if improving; then taper to 2–3 nights/week on relapse-prone facial zones.
Light spacing: apply on non-light days or ≥8–12 h away from NB-UVB/excimer sessions.

Efficacy by Site (Evidence Overview)

Table 1. Expected response patterns by zone.

Site	Early signal	Typical trajectory	Notes
Face/neck	Perifollicular islands by 4–8 wks	Higher probability of F-VASI50/75 by 12–24 wks	Best with NB-UVB or excimer
Trunk/limbs	Islands by 8–12 wks	Steady but slower; extend course	Alternate with short steroid pulses off-face if stalled
Acral (hands/feet)	Late and sparse islands	Prolonged timelines; partial fill-in common	Add excimer; rigorous friction reduction

Interpretation tip: Use standardized photos and F-/T-VASI to detect small but meaningful island growth even before visible coalescence.

Combinations with Light Therapy

NB-UVB 311 nm + tacrolimus 0.1% is a face/fold-sparing backbone; separate application and light by ≥8–12 h.
Excimer 308 nm + tacrolimus speeds facial rims and small focal macules; useful in periorificial sites.
Steroid “pulses” (off-face) can be interleaved if response plateaus on trunk/limbs.

Special Populations & Sites

Pediatrics: preferred first-line on face/neck; monitor for stinging; emphasize sunscreen and gentle cosmetics if needed.
Folds/eyelids: tacrolimus avoids atrophy risk vs chronic steroids; apply thinly.
Leukotrichia: expect slower skin fill-in; consider surgical options if stable and cosmetically critical.

Safety, Counseling & Adherence

Local reactions: transient burning/stinging (usually settles within days to weeks); use moisturizers and nighttime application.
No skin atrophy or striae risk, making it suitable for chronic/maintenance use on face/folds.
Sun habits: routine photoprotection; avoid application immediately before light sessions.
Adherence aids: fingertip-unit dosing guides; photo diaries to visualize island growth.

Outcome Tables (framework)

Table 2. Populate with cohort/RCT numerics when abstracted.

Endpoint	Face/neck	Trunk/limbs	Acral	With NB-UVB / Excimer
F-VASI50 @ 12–24 wks	—	—	—	—
Time to first islands	—	—	—	—
Relapse at 6–12 mo	—	—	—	—