Sarkar Rashmi, Dogra Sunil, Vinay Keshavamurthy, Sinha Surabhi, Narayan Vignesh R, Kumaran Muthu Sendhil, Podder Indrashis, Jagadeesan Soumya, Bhalla Mala, Das Anupam, Lakhani Ridhima, Sharma Richa, Barua Shyamanta, Somani Vijay K, Thappa D M, Mysore Venkataram, Swarnkar Bhavesh
Department of Dermatology, Lady Hardinge Medical College and Associated KSCH and SSK Hospital, New Delhi, India.
Department of Dermatology Venereology & Leprology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
Clin Cosmet Investig Dermatol. 2024 Dec 17;17:2875-2886. doi: 10.2147/CCID.S455602. eCollection 2024.
Tacrolimus, a topical calcineurin inhibitor (TCI) with immunomodulatory effects, is considered a viable treatment option for vitiligo. A consensus building exercise was undertaken to determine the role and clinical utility of topical tacrolimus in the management of vitiligo using input from experts in the field of dermatology.
Seventeen experts collaborated to create consensus statements using a modified Delphi methodology. A questionnaire on effectiveness, safety and utility of topical tacrolimus in different types of vitiligo, duration, frequency, monotherapy and combination and other aspects was shared, and a concordance rate of 75% was preset to have consensus. A physical meeting was conducted to discuss statements, which did not achieve consensus.
Amongst 34 statements derived from round one, consensus was not achieved for 9 statements. In the second round, consensus was achieved for 2/9 statements, hence in the physical meeting, discussion was done to reframe the remaining seven statements. Apart from these 34 statements, questions pertaining to "Vitiligo: types and presentation in clinical practice", where consensus was not intended, are presented as descriptive statements.
Topical tacrolimus ointment has a favorable risk benefit profile to be used as one of the first-line agents for vitiligo. Combination of topical tacrolimus and narrow band Ultraviolet-B (NBUVB) was recommended as an effective treatment for non-segmental vitiligo. Recommended frequency of application was once or twice daily for optimal results. Apart from a transient burning sensation, topical tacrolimus has a favorable safety profile.
他克莫司是一种具有免疫调节作用的外用钙调神经磷酸酶抑制剂（TCI），被认为是治疗白癜风的一种可行选择。通过皮肤科领域专家的意见，开展了一项共识构建活动，以确定外用他克莫司在白癜风治疗中的作用和临床效用。
17位专家合作采用改良的德尔菲法制定共识声明。共享了一份关于外用他克莫司在不同类型白癜风中的有效性、安全性和效用、持续时间、频率、单一疗法和联合疗法等方面的调查问卷，并预设75%的一致率以达成共识。召开了一次面对面会议来讨论未达成共识的声明。
在第一轮得出的34项声明中，9项声明未达成共识。在第二轮中，9项声明中的2项达成了共识，因此在面对面会议上，对其余7项声明进行了重新表述的讨论。除了这34项声明外，与“白癜风：临床实践中的类型和表现”相关的问题（对此不打算达成共识）以描述性声明的形式呈现。
外用他克莫司软膏具有良好的风险效益比，可作为白癜风的一线治疗药物之一。推荐外用他克莫司与窄谱中波紫外线（NBUVB）联合使用作为非节段性白癜风的有效治疗方法。为获得最佳效果，推荐使用频率为每日一次或两次。除了短暂的烧灼感外，外用他克莫司具有良好的安全性。
