Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients

Yael Renert-Yuval, Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
Khaled Ezzedine, Hôpital Henri Mondor, Department of Dermatology and Université Paris Est Créteil, Epidemiology in Dermatology and Evaluation of Therapeutics, Créteil, France.
Pearl Grimes, Departments of Dermatology, University of California, Los Angeles.
David Rosmarin, Department of Dermatology, Indiana University School of Medicine, Indianapolis.
Lawrence F. Eichenfield, Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego.
Leslie Castelo-Soccio, National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland.
Victor Huang, Department of Dermatology, University of California, Davis.
Seemal R. Desai, Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas.
Samantha Walsh, Hunter College Library, New York, New York.
Jonathan I. Silverberg, George Washington University School of Medicine and Health Sciences, Washington, DC.
Amy S. Paller, Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Michele Rodrigues, Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia.
Mark Weingarten, Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
Shanthi Narla, Department of Dermatology, St Luke's University Health Network, Easton, Pennsylvania.
Jackie Gardner, Vitiligo Support International, Lynchburg, Virginia.
Michael Siegel, Pediatric Dermatology Research Alliance, Portland, Oregon.
Sidra Ibad, Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
Nanette B. Silverberg, Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.

Document Type

Journal Article

Publication Date

3-13-2024

Journal

JAMA dermatology

DOI

10.1001/jamadermatol.2024.0021

Abstract

IMPORTANCE: Evidence-based recommendations for the treatment of vitiligo in pediatric, adolescent, and young adult patients in the US are needed. OBJECTIVE: To develop evidence- and consensus-based expert recommendations on the diagnosis and treatment of vitiligo in young patients. EVIDENCE REVIEW: A process was developed to produce consensus recommendations addressing questions regarding pediatric vitiligo. A librarian-conducted literature review was performed using articles that met the inclusion criteria: published in English, containing primary data (including meta-analysis) and pediatric-specific data, and analysis of 6 or more patients. Included articles were graded by the Strength of Recommendation Taxonomy criteria and Oxford Centre for Evidence-based Medicine's Levels of Evidence and Grades of Recommendation. Research questions were reviewed on May 9, 2022, through a video conference. One month after the conference, participants participated in an online survey documenting their level of agreement with the generated statements, using a 5-point Likert scale. FINDINGS: Articles on topical corticosteroids and/or topical calcineurin inhibitors (n = 50), topical Janus kinase inhibitors (n = 5), pseudocatalase (n = 2), and microdermabrasion (n = 2) met inclusion criteria. Forty-two recommendations were made on the diagnosis of vitiligo and optimal topical therapeutics, with 33 recommendations obtaining a 70% or greater composite agreement and strong agreement. Topical calcineurin inhibitors twice daily, topical corticosteroids with time limitation due to atrophy risk, and topical ruxolitinib, 1.5%, cream-used off-label for patients younger than 12 years and limited to nonsegmental vitiligo-were identified as evidence-based first-line therapies in the management of pediatric and adolescent patients, with specific guidance on age-based data, minimum therapeutic trial of 6 months or greater, prolonged therapy to prevent recurrence, and the positive benefit of coordinated use of UV therapeutic sources. CONCLUSIONS AND RELEVANCE: Evidence supports the use of topical calcineurin inhibitors, topical corticosteroids, and topical Janus kinase inhibitors as effective therapeutics for vitiligo in pediatric, adolescent, and young adult patients, with specific decisions on choice of agent based on factors such as site location, body surface area, and age.

Department

Dermatology

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