Objective
Evidence-based recommendations are needed for the treatment of vitiligo in pediatric, adolescent, and young adult patients in the U.S. The goal is to develop expert recommendations based on evidence and consensus regarding the diagnosis and treatment of vitiligo in younger patients.
Evidence
A process was developed to produce consensus recommendations addressing questions related to pediatric vitiligo. A literature review was conducted by librarians using articles that met the inclusion criteria: published in English, containing primary data (including meta-analyses) and specific pediatric data, and analyzing 6 or more patients.
Included articles were rated according to the Oxford Centre for Evidence-Based Medicine´s taxonomy of recommendation strength, evidence levels, and recommendation grades. Research questions were reviewed on May 9, 2022, via videoconference. One month after the conference, participants took 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 the inclusion criteria.
Forty-two recommendations were made regarding the diagnosis of vitiligo and optimal topical therapy, with 33 recommendations achieving a composite agreement of 70% or more and strong agreement.
Topical calcineurin inhibitors twice daily, topical corticosteroids with time limitations due to the risk of atrophy, and topical ruxolitinib 1.5% cream (used off-label in patients under 12 years and limited to non-segmental vitiligo) were identified as first-line evidence-based products for treating pediatric and adolescent patients. Specific guidance was provided based on age-related data, a minimum therapeutic trial of 6 months or more, prolonged therapy to prevent recurrence, and the positive benefit of coordinated UV therapeutic sources.
Conclusions
Evidence supports the use of topical calcineurin inhibitors, topical corticosteroids, and topical Janus kinase inhibitors as effective therapies for vitiligo in pediatric, adolescent, and young adult patients. Specific decisions regarding the choice of agent should be based on factors such as site location, body surface area, and age.
