What is the role of topical corticosteroids in the management of vitiligo, and how should they be prescribed?

Role of topical corticosteroids in vitiligo management: Topical corticosteroids are commonly used as a first-line treatment option to reduce inflammation and potentially stimulate repigmentation in vitiligo-affected skin.

Recommended prescribing practices: Use the lowest potency corticosteroid that is effective, especially on sensitive areas such as the face and flexures, to minimise risks of skin atrophy and other side effects. Treatment duration should be limited, typically not exceeding 4 weeks for very potent corticosteroids and 8 weeks for potent corticosteroids, with breaks between courses to reduce adverse effects. Continuous use of potent or very potent corticosteroids should be avoided to prevent irreversible skin damage. Regular review is recommended to monitor for side effects such as skin atrophy. In children, very potent corticosteroids are generally avoided, and potent corticosteroids should be used cautiously and for short durations only.

These prescribing principles are extrapolated from UK guidelines on topical corticosteroid use in inflammatory skin conditions such as psoriasis and atopic eczema, as specific NICE guidance on vitiligo topical corticosteroid use is limited. The emphasis is on balancing efficacy with safety by selecting appropriate potency, limiting duration, and monitoring adverse effects.