Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients
abstract
This abstract is available on the publisher's site.
Access this abstract nowIMPORTANCE
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.
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts
Additional Info
Disclosure statements are available on the authors' profiles:
Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients
JAMA Dermatol 2024 Mar 13;[EPub Ahead of Print], Y Renert-Yuval, K Ezzedine, P Grimes, D Rosmarin, LF Eichenfield, L Castelo-Soccio, V Huang, SR Desai, S Walsh, JI Silverberg, AS Paller, M Rodrigues, M Weingarten, S Narla, J Gardner, M Siegel, S Ibad, NB SilverbergFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The treatment landscape for vitiligo is rapidly evolving. Recent insights into the pathomechanisms of the disease have set the stage for the development of targeted therapies for this complex immune-mediated disorder that affects pediatric, adolescent, and adult populations globally and has a major impact on the quality of life. Notwithstanding these advances, guidelines on the management of vitiligo in pediatric, adolescent, and young adult patients in the US are lacking, despite half of the vitiligo cases having an onset in the first 2 decades of life. This recent publication features consensus recommendations based on published evidence reviewed systematically by an esteemed group of US and international experts in vitiligo. In addition to graded evidence for topical calcineurin inhibitors (TCIs), topical corticosteroids (TCSs), topical JAK inhibitors (JAKi), and topical pseudocatalase (the latter of which lacks sufficient evidence), general consensus recommendations for the management of vitiligo in young patients as well as a therapeutic paradigm are included.
Some of the key takeaways from the evidence-based expert recommendations include that TCIs, TCSs, JAKi, and phototherapy (narrow-band ultraviolet B or 308-nm excimer laser) are among the first-line treatments for vitiligo in this younger patient population. For children younger than 12 years, TCSs and TCIs are the first-line treatments for nonsegmental vitiligo; whereas, for children aged 12 years or older with a body surface area of involvement of 10% or less, topical JAKi (ruxolitinib 1.5% cream twice daily) is included as a first-line therapy, and a minimum of 6 months of therapy is recommended. The authors stress the importance of early and sustained intervention but acknowledge that future studies are needed to further demonstrate the role of early intervention in controlling long-term outcomes and memory T–cell accumulation.