Topical Tacrolimus in Vitiligo: Consensus Paper from the Pigmentary Disorders Society

Tacrolimus, a topical calcineurin inhibitor (TCI) with immunomodulatory effects, is considered a viable treatment option for vitiligo. A consensus building exercise was undertaken to determine the role and clinical utility of topical tacrolimus in the management of vitiligo using input from experts in the field of dermatology.

Seventeen experts collaborated to create consensus statements using a modified Delphi methodology. A questionnaire on effectiveness, safety and utility of topical tacrolimus in different types of vitiligo, duration, frequency, monotherapy and combination and other aspects was shared, and a concordance rate of 75% was preset to have consensus. A physical meeting was conducted to discuss statements, which did not achieve consensus.

Amongst 34 statements derived from round one, consensus was not achieved for 9 statements. In the second round, consensus was achieved for 2/9 statements, hence in the physical meeting, discussion was done to reframe the remaining seven statements. Apart from these 34 statements, questions pertaining to "Vitiligo: types and presentation in clinical practice", where consensus was not intended, are presented as descriptive statements.

Topical tacrolimus ointment has a favorable risk benefit profile to be used as one of the first-line agents for vitiligo. Combination of topical tacrolimus and narrow band Ultraviolet-B (NBUVB) was recommended as an effective treatment for non-segmental vitiligo. Recommended frequency of application was once or twice daily for optimal results. Apart from a transient burning sensation, topical tacrolimus has a favorable safety profile.