Kavitha S. B1, Tulasi Jarang2, Narsimha Rao Netha Gurram3
Vitiligo, the commonest of all pigmentary disorders, is an idiopathic, acquired cutaneous achromia, characterised by circumscribed, chalky white macules. It may also involve the pigment epithelium of the eyes, the inner ear and the leptomeninges. Although, vitiligo can begin at any age, it develops before the age of 20 years in 50% of the patients and before the age of 10 years in 25% of patients.
MATERIALS AND METHODS
The study was conducted for a period of one year with 6 months active intervention. A group of 60 consecutive children attending the outpatient Department of Dermatology were included in this study. The same patients were acting as controls.
Grade 4 response was seen in 12 cases (60%) who were on mometasone (VV-20%, focal-30%, segmental-10%), in 10 cases (50%) on tacrolimus (VV-20%, focal-30%) and in 4 cases (20%) on bFGF (focal). Lesions on the face and neck showed grade 4 response in 16 cases (mometasone-8, tacrolimus-6 and bFGF-2), extremities in 6 cases. On the whole grade, 4 response was observed more with mometasone (60%) followed by tacrolimus (50%). Grade 3 response was observed with bFGF (30%).
Topical mometasone was very effective among the 3 drugs used in childhood vitiligo showing grade 4 repigmentation in all types of vitiligo except mucosal vitiligo. Tacrolimus proved almost as effective as mometasone to restore skin colour in lesions of vitiligo in children. Because it does not produce atrophy or other adverse effects, tacrolimus may be very useful for younger patients, and for sensitive areas of the skin such as eyelids, it should be considered in other skin disorders currently treated with topical steroids for prolonged periods. Topical basic fibroblast growth factor though less effective than mometasone and tacrolimus, but can be tried as initial therapy in resistant cases such as segmental vitiligo as initial therapy of small vitiligo patches when physicians may not like to initiate high risk alternative such as steroids/PUVA as initial therapy in paediatric age where psoralens and steroids should not be initiated because of long-term risks associated with prolonged usage of them as adjunctive therapy to steroids or tacrolimus so as to reduce the dose and duration of steroids or tacrolimus for increasing the overall safety to the child.