Early treatment may improve repigmentation in pediatric segmental vitiligo

In children with segmental vitiligo (SV), moderate repigmentation may be reached through early intervention with topical calcineurin inhibitors, corticosteroids, and phototherapy, according to a recent study published in Pediatric Dermatology.¹

Vitiligo presents as selective melanocyte loss leading to white macules or patches.² Compared with nonsegmental vitiligo, SV is significantly more common in pediatric patients.¹ Additionally, traditional therapies such as topical corticosteroids, calcineurin inhibitors, and phototherapy have been reported as less effective for this condition.

“Treatment options for SV, especially in pediatric and adolescent patients, remain limited,” noted investigators.

Assessing SV therapies

The review was conducted to evaluate the safety and efficacy of current and emerging pediatric SV therapies. Articles were identified through searches of the Embase, Cochrane, PubMed, and Scopus databases. Two independent reviewers performed title and abstract screening, followed by full-text screening.

Peer-reviewed articles published from January 2015 to March 2025 were included in the analysis. Additional inclusion criteria included human studies and being published in English. Those not available in English, without full text available, not discussing pediatric SV treatment outcomes, and without human subjects were excluded.

There were 10 studies included in the final analysis, comprising 3 case reports, 1 case series, 1 prospective cohort study, 3 retrospective cohort studies, and 2 observational, cross-sectional studies. Study participants were aged 4 to 18 years, and sex distribution varied across studies from 28.9% of patients being male to 75%.

Topical and JAK inhibitor therapies

Topical interventions assessed included clobetasol propionate (0.05%) and furoate (0.1) in 92.5% of cases and calcineurin inhibitors in 55%. However, investigators did not separately report outcomes related to SV repigmentation.

Ruxolitinib (1.5%) was assessed in 16 pediatric patients, 2 of whom achieved complete repigmentation and 10 achieved partial response, defined as over 50% repigmentation. Additionally, a 4-year-old male patient received tofacitinib combined with narrowband UVB therapy and achieved full repigmentation after 8 weeks. No local adverse events were reported in this patient.

In comparison, systemic agents such as methotrexate and hydroxychloroquine (HCQ) showed minimal effectiveness for repigmentation in limited studies. Seventy percent repigmentation was achieved in a female patient receiving calcipotriol, oral steroids, calcineurin inhibitors, narrowband UVB, then HCQ 200 mg/day.

Surgical and combination interventions

Good to excellent repigmentation was reported for autologous melanocyte suspension, with a rate of 84.3% at 6 months in a population aged a mean 24.3 years. In comparison, autologous cultured epithelium grafting had a rate for over 50% repigmentation of 88.33% in an SV subpopulation. This data highlighted superiority from surgical methods.

Combination therapies were also effective, including 308-nm excimer light and topical tacrolimus with complete repigmentation in 35.6% of patients and at least 75% repigmentation in 77.8% overall. Patients treated earlier and with facial lesions experienced better treatment outcomes.

Safety profiles were favorable for topical corticosteroids and topical calcineurin inhibitors, with burning, transient erythema, and postinflammatory hyperpigmentation reported as adverse effects. For phototherapy, adverse events included scaling, minor itching, photosensitivity, and erythema.

Implications

There were no serious adverse events reported. Additionally, the data indicated both topical and phototherapeutic options as well tolerated. While complications were rare in surgical methods, these were indicated as significant and included scar formation with hypertrophic appearance, postgraft infection, and new leukoplakia at graft sites.

A moderate risk of bias was reported across the trials. Overall, the data highlighted moderate repigmentation from early treatment with topical calcineurin inhibitors, steroids, and phototherapy in pediatric patients with SV.

“Emerging agents like topical JAK inhibitors hold promise but require further study,” wrote investigators.

References

1. Ghani H, Hoffman V, Shah A, Abrantes T, Bercovitch L. Shining light on treatments: a systematic review of existing therapies for pediatric segmental vitiligo. Pediatric Dermatology. Published online April 5, 2026. doi:10.1111/pde.70215
2. Bergqvist C, Ezzedine K. Vitiligo: a review. Dermatology. 2020;236(6):571-592. doi:10.1159/000506103