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Two Therapeutic Challegens
Two Therapeutic Challegens
Blackwell
Oxford,
International
IJD
0011-9059
46 2007 The
UK
Publishing,
International
Journal of
Ltd.
Dermatology
Society of Dermatology
Vitiligo is the most common of the primary disorders of used in Brazil) showed no improvement. The patch was
pigmentation. It affects 1% of the worlds population and its getting larger and the boys parents complained that their son
onset in at least half of the cases occurs before the age of 20.1 was feeling unhappy with the lesion, and facing relationship
It is characterized by a selective destruction of melanocytes problems at school. No other macule was observed during
resulting in patches of skin depigmentation.1,2 There is a familial examination. Laboratory tests were on the normal range.
incidence of 30%, with inheritance pattern not explained There were no familial vitiligo cases. Focal vitiligo was
by simple Mendelian genetics, otherwise characterized by diagnosed and treatment with pimecrolimus 1% cream twice
incomplete penetrance, multiple susceptibility loci, and a day was started.
genetics heterogenecity.1,3 Vitiligo is clinically divided into After 4 months of treatment, the positive result was
localized and generalized forms.4 It is a therapeutic challenge, unquestionable, with almost complete pigmentation of the
and spontaneous regression of this disease is unusual.5 treated patch (Fig. 2). One year after treatment, there was no
Eyebrows, eyelids, and genital vitiligo are a therapeutic relapse of vitiligo.
dilemma, especially in children. The possible side-effects with
topical corticosteroids therapy and the difficulties for choosing
any other adequate treatment option are a major concern.5,6
The new calcineurin inhibitors tacrolimus and pimecrolimus,
with their known topical safety profile, have been reported as
a therapeutic option for vitiligo.7,8 We present here two children,
one with vitiligo of the eyelids and eyebrows and the other
with genital vitiligo, both treated with pimecrolimus 1%
cream, with almost full repigmentation of the treated lesions,
showing that pimecrolimus could be an effective option for
the treatment of vitiligo in children, particularly for these
special skin areas.
Clinical Case 1
International Journal of Dermatology 2007, 46, 986989 2007 The International Society of Dermatology
Leite and Leite Periocular and genital vitiligo in children Pharmacology and therapeutics 987
Figure 2 Eyebrow and eyelid vitiligo after treatment Figure 4 Genital vitiligo after treatment
2007 The International Society of Dermatology International Journal of Dermatology 2007, 46, 986 989
988 Pharmacology and therapeutics Periocular and genital vitiligo in children Leite and Leite
in involved and adjacent uninvolved skin; significantly genital vitiligo are not broad. Children and adolescent skin
increased tumor necrosis factor (TNF) expression in involved characteristics make this area prone to local therapy side-
and uninvolved skin; and significantly increased interleukin- effects. Topical corticosteroids are the first line of therapy
10 expression in involved and uninvolved skin. After treatment, for child and adolescent vitiligo.5 Children treated with
TNF expression decreased in the depigmented and adjacent corticosteroids should be monitored for local side-effects, like
uninvolved skin.14 teleangiectasias, cutaneous atrophy, or striae.5
Tacrolimus ointment and pimecrolimus cream, novel However, more studies with large number of patients are
topical immunomodulatory drugs, are used for the treatment needed to characterize pimecrolimus cream as a first-line
of atopic dermatitis in both adults and children.15 In recent therapeutic option for vitiligo. Because pimecrolimus has
studies, tacrolimus has been reported to induce repigmentation been shown to be a safe treatment to atopic dermatitis, even
in vitiligo patients.7,16 Grimes, in an open-label study, docu- with recent concerns about carcinogeneis, and its side-effect
mented the efficacy of tacrolimus ointment in six patients profile is poor,1921 it could be an interesting option for focal
with generalized vitiligo. Five of the six patients achieved vitiligo treatment, mainly when there is serious concern about
moderate to excellent repigmentation (50 100%), and one local side-effects as in periocular and genital areas in children.
patient had 25 to 50% repigmentation.17 Lepe, in a double-
blind study assessing the safety and efficacy of topical 0.1%
tacrolimus vs. 0.05% clobetasol propionate in children with References
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2007 The International Society of Dermatology International Journal of Dermatology 2007, 46, 986 989