Vitiligo — SCE Dermatology MCQ

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ModerateInflammatory DermatosesVitiligoSCE Dermatology

A 26-year-old man with Fitzpatrick skin type VI presents with well-demarcated depigmented patches on his hands and periorbital area. Wood lamp examination shows bright blue-white fluorescence of the affected areas. What is the most appropriate first-line treatment for limited disease (<5% BSA)?

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Correct answer: D — Topical tacrolimus 0.1%

The correct answer is D, topical tacrolimus 0.1%. This patient has classic vitiligo (well-demarcated depigmented macules with characteristic bright blue-white Wood lamp fluorescence, distinguishing it from other hypopigmenting conditions) affecting sensitive, thin-skinned sites (hands, periorbital area) with limited body surface area involvement. UK BAD guidance identifies topical calcineurin inhibitors, with tacrolimus having the strongest evidence base, as the preferred first-line agent for localized vitiligo, particularly on the face and periorbital skin, because these areas are prone to steroid-induced atrophy, telangiectasia and periorbital complications including glaucoma risk with prolonged potent steroid use. Tacrolimus achieves comparable repigmentation to potent steroids on facial sites without this cumulative skin-thinning risk, making it the safer and guideline-endorsed choice for this distribution and extent of disease.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions