Topical Corticosteroids in Vitiligo: Potency Selection, Intermittent Regimens, and Safety

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Key Takeaways

  • First-line option on trunk/limbs; avoid continuous high-potency use on face, folds, genital skin—prefer calcineurin inhibitors there.
  • Intermittent schedules (e.g., weekend therapy or 2–3 weeks on / 1 week off) reduce atrophy risk while maintaining efficacy.
  • Combinations with NB-UVB or excimer 308 nm accelerate repigmentation versus monotherapy.
  • Pediatric use: lower potency, shorter cycles, close skin checks; switch to tacrolimus/pimecrolimus for sensitive zones.

Abstract

Topical corticosteroids remain a core therapy for nonsegmental vitiligo on trunk and limbs. This article summarizes site-based potency choices, intermittent regimens to mitigate atrophy, synergy with phototherapy, pediatric use, and practical monitoring of adverse effects.

Potency Selection by Site

Table 1. Suggested potency by anatomic zone.
Zone Suggested potency Notes
Trunk, non-acral limbs Medium → high Use cream/ointment; assess at 8–12 weeks
Acral (hands/feet) High (limited response) Add excimer / NB-UVB early
Face/neck, folds, genital Low (short courses only) Prefer tacrolimus/pimecrolimus for maintenance

Intermittent & Rotational Regimens

Table 2. Practical schedules.
Regimen Example Rationale
Weekend therapy Sat–Sun corticosteroid; Mon–Fri calcineurin inhibitor/emollient Maintains effect, lowers atrophy risk
Pulsed cycle 2–3 weeks on / 1 week off Skin recovery interval
Step-down High→medium→low potency over 6–12 weeks Consolidate gains, taper exposure

Combination with Phototherapy

  • NB-UVB 311 nm 2–3×/week plus topical steroid on non–face/neck lesions increases speed and magnitude of response.
  • Excimer 308 nm for focal edges or acral targets; apply steroid on off-days.
  • Transition to calcineurin inhibitors for maintenance in sensitive areas.

Pediatric Considerations

  • Prefer low–medium potency, short cycles, and early switch to tacrolimus/pimecrolimus for face/folds.
  • Educate on fingertip-unit dosing; monitor for irritation and adherence.
  • Phototherapy combinations should follow pediatric safety protocols.

Safety & Monitoring

Table 3. Adverse effects and mitigation.
Risk Pattern Mitigation
Atrophy/telangiectasia Face/folds risk Intermittent use; switch to calcineurin inhibitors
Striae Prolonged high potency Limit duration; step-down
Perioral dermatitis/rosacea Facial use Short courses; rapid transition off steroid
Ocular risk (peri-ocular) Rare with proper use Avoid eyelid steroids; use tacrolimus instead

Outcome Tables (framework)

Table 4. Populate with study numerics.
Outcome Corticosteroid Comparator Interpretation
F-VASI % change (12–24 wks) — Vehicle/calcineurin Stronger on trunk/limbs
Responder (F-VASI50/75) — — Improves with phototherapy
Relapse off-treatment — — Maintenance needed
AE rate (atrophy/telangiectasia) — — Lower with intermittent use

Limitations

Heterogeneity in potency, vehicle, and endpoints across studies; limited long-term off-drug durability data, especially for acral disease.

References

  1. RCTs/split-body and cohort studies of topical corticosteroids in vitiligo by anatomic site.
  2. Guidelines on potency selection, intermittent regimens, and pediatric safety.
  3. Combination studies with NB-UVB and excimer 308 nm.
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