Shining Light on Treatments: A Systematic Review of Existing Therapies for Pediatric Segmental Vitiligo

Vitiligo is a common depigmenting disorder affecting 0.5%-2% of the global population, primarily presenting as segmental (SV) or non-segmental vitiligo (NSV). SV accounts for 3.5%-20.5% of cases, characterized by a rapid yet stable course and reduced responsiveness to conventional therapies. Managing pediatric SV remains challenging. This systematic review assesses the safety and efficacy of current and emerging treatments for pediatric SV over the past decade.

A systematic literature search was conducted in PubMed, Embase, Cochrane, and Scopus from March to April 2025, following PRISMA 2020 guidelines. Two independent reviewers screened studies, with a third resolving disagreements. Included studies were randomized controlled trials, case reports, case series, and cohort studies on pediatric SV treatments published within the last 10 years.

From 1107 records, 10 studies met inclusion criteria, comprising 2085 pediatric patients (843 with SV). Treatments varied and included autologous cultured epithelium grafting (ACEG), melanocyte-keratinocyte transplantation procedures (MKTP), phototherapy, and topical immunosuppressants. Repigmentation rates varied, with some studies reporting over 70% repigmentation, especially in facial lesions. Adverse events were generally mild, mostly limited to erythema, burning, blistering, and irritation; one infection occurred post-ACEG. Most studies demonstrated moderate-to-low evidence quality and moderate risk of bias.

Early intervention with topical calcineurin inhibitors, corticosteroids, and phototherapy can achieve moderate repigmentation in pediatric SV. In stable disease, surgical modalities such as MKTP and ACEG demonstrate the highest efficacy, while emerging therapies including topical Janus-kinase (JAK) inhibitors show promising potential pending further investigation.