A 26-year-old man with stable vitiligo over the face asks about topical therapy suitable for long-term use around the eyes. Which class is preferred because it lacks the atrophogenic risk of topical corticosteroids?
- A Topical 5-fluorouracil
- B Superpotent corticosteroids such as clobetasol propionate
- C Topical calcineurin inhibitors such as tacrolimus ✓
- D Anthralin
Correct answer: C. Topical calcineurin inhibitors such as tacrolimus
Explanation
Tacrolimus and pimecrolimus inhibit T-cell cytokine transcription without affecting collagen synthesis, so they cause no atrophy, telangiectasia, or striae, making them ideal for thin skin sites like the face, eyelids, neck, and flexures. Superpotent steroids risk atrophy at these sites, and 5-fluorouracil and anthralin are irritants used in other disorders, not vitiligo of delicate areas.
Reference: Rook's Textbook of Dermatology, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.