DOI: 10.1111/pde.
14159
BRIEF REPORT
Tofacitinib cream plus narrowband ultraviolet B phototherapy
for segmental vitiligo in a child
Abstract
Segmental vitiligo often presents in childhood and tends
to be more recalcitrant to therapy than generalized viti-
ligo. Recently, Janus kinase inhibitors have emerged as a
promising treatment option, with some reports suggesting
that concomitant ultraviolet light exposure may enhance
therapeutic response. Here, we present a child with seg-
mental vitiligo who responded rapidly and completely to
treatment with tofacitinib cream plus phototherapy.
1 |  I NTRO D U C TI O N
Vitiligo is a common immune-mediated disease marked by white
macules and patches on the skin that result from the destruction
of functional melanocytes. Vitiligo most commonly presents in a
generalized distribution, but it may also be localized, either in a
focal (non-segmental) or segmental (linear, bandlike or blocklike,
or Blaschkoid) distribution.1 Segmental vitiligo (SV) typically has
an earlier age of onset and is less responsive to treatment than
generalized vitiligo.1
Recent progress in the understanding of vitiligo pathogenesis has
led to the use of Janus kinase (JAK) inhibitors, with several reports
(A) (B)
F I G U R E 1   Response to tofacitinib 2% cream plus narrowband ultraviolet B phototherapy. A, Patient with well-demarcated depigmented
patch involving his right chin and anterior neck. B, After 3 mo of treatment, only three depigmented linear macules on the chin remained. C,
After 6 mo of treatment, there was complete repigmentation
Pediatric Dermatology. 2020;00:1–2. wileyonlinelibrary.com/journal/pde© 2020 Wiley Periodicals, Inc.     1
Pediatric
Dermatology
in the literature demonstrating their efficacy, including when used
topically. 2-4 While the vast majority of the reports consist of adult
patients, there is a single case series of patients with non-segmental
vitiligo that includes an adolescent.3 Importantly, it has been sug-
gested that concomitant ultraviolet light may be necessary in order
to achieve repigmentation with JAK inhibitors.5
2 | C A S E R E P O RT
A four-year-old boy was referred for evaluation of segmental vitiligo
that had developed abruptly about 6 months previously. He had been
using alclometasone 0.05% cream twice daily for 6 weeks without im-
provement. On physical examination, he had a well-demarcated de-
pigmented patch involving his right chin and anterior neck (Figure 1A).
Given the prominent facial involvement and that he was going to start
elementary school later in the year, the patient's family was interested
in optimizing the chances of successful treatment. He discontinued
alclometasone and started tofacitinib 2% cream twice daily along with
narrowband ultraviolet B phototherapy using a handheld unit (admin-
istered at home) to the affected area three times weekly. Freckling
was observed within 4 weeks, and after 3 months, only three depig-
mented linear macules remained on the chin (Figure 1B). At 6 months,
there was complete repigmentation (Figure 1C). Although a taper
(C)
|
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2       Pediatric
Dermatology
was recommended, the patient discontinued treatment after another
month, and the area remained fully repigmented for approximately
6 months before a few depigmented macules began to reappear,
at which time he restarted the prior regimen. The patient tolerated
treatment well without any adverse effects.
3 |  D I S CU S S I O N
To our knowledge, this is the first reported case of successful use of a
topical JAK inhibitor plus phototherapy for the treatment of vitiligo in
a preadolescent child, as well as the first for SV. The rapid, near com-
plete reversal of disease in <3 months is dramatic and unexpected
with usual therapies. It is especially compelling given that SV is often
refractory to treatment.1 In light of recent results from the Phase II
trial of ruxolitinib 1.5% cream monotherapy in non-segmental vitiligo
in adults showing that only 12% of subjects achieved a 90% improve-
ment in facial vitiligo over 24 weeks,4 this successful result in only
12 weeks supports the notion that combination treatment with a
JAK inhibitor plus phototherapy is synergistic, consistent with other
reports. 2-3,5 We suspect that initiating treatment early in the disease
course may also contribute to improved efficacy. Given the psycho-
social burden associated with facial vitiligo and the lack of highly ef-
fective therapies, the growing body of literature showing efficacy
of topical JAK inhibitors for treatment of facial vitiligo is promising.
When compared to systemic JAK inhibitors, topical agents are asso-
ciated with a more favorable safety profile, making them especially
appealing for the treatment of localized areas, particularly in the
pediatric population. We look forward to results of other investiga-
tions of these agents, including for the treatment of SV.
K E Y WO R D S
JAK inhibitor, Janus kinase inhibitor, pediatric, segmental vitiligo,
tofacitinib, topical, treatment, vitiligo
C O N FL I C T O F I N T E R E S T
BGC has received honoraria and/or fees from Aclaris, Arena
Pharmaceuticals, Regeneron, Sanofi-Genzyme, and Pfizer.
BRIEF REPORT
Brianna Olamiju BA1
Brittany G. Craiglow MD2,3
1
Yale School of Medicine, New Haven, Connecticut
2
Department of Dermatology, Yale University School of
Medicine, New Haven, Connecticut
3
Dermatology Physicians of Connecticut, Fairfield, Connecticut
Correspondence
Brittany G. Craiglow, MD, Department of Dermatology, Yale
School of Medicine, PO Box 208059, New Haven, CT 06520,
USA.
Email: brittany.craiglow@yale.edu
ORCID
Brittany G. Craiglow  https://orcid.org/0000-0001-8970-7691
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