Tacrolimus-Associated Hyperpigmentation: A Case Report and Literature Review

Topical tacrolimus is an immunomodulator commonly used in the management of vitiligo. We report a case of tacrolimus-associated hyperpigmentation in a nine-year-old girl with non-segmental vitiligo, who presented with depigmented patches on the eyelid and trunk. The depigmented eyelid patch improved with topical tacrolimus but developed localized, paradoxical hyperpigmentation at the treated site. She was managed with alternating topical corticosteroids and tacrolimus alongside photoprotection; after six weeks, the trunk demonstrated full repigmentation, but the eyelid lesion developed marked hyperpigmentation temporally associated with tacrolimus use. Other causes of pigmentation were excluded, and the discoloration resolved completely within six weeks of discontinuing treatment. To further examine this presentation, we reviewed the literature for reports of similar pigmentary changes associated with tacrolimus. This review encompassed both oral and topical use in patients with and without vitiligo.