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Topical tacrolimus 0.1%, applied twice daily, is the first-line therapy for patients with vitiligo affecting less than 20% of the patient’s body.
Patients with 20-25% involvement may benefit more from narrowband UVB or oral PUVA therapy. However, patients should be counseled that there is a risk of severe phototoxic reactions with PUVA therapy. Generally, the fingertips and genitals are most difficult to treat, while the face and chest can be expected to respond well. Years of treatment are usually needed. Importantly, vitiligo increases a patient’s risk of developing skin cancers, and more thorough skin screening methods should be considered.