Abstract
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Background: Segmental Vitiligo (SV) is a localized, often early-onset form of vitiligo with a unilateral distribution and rapid stabilization. Topical corticosteroids and calcineurin inhibitors remain mainstays but are limited by side effects and variable efficacy. Crisaborole 2% ointment, a selective phosphodiesterase-4 (PDE4) inhibitor, downregulates proinflammatory cytokines such as TNF-α, IL-17, and IL-23, implicated in melanocyte cytotoxicity. Although widely used in atopic dermatitis, its potential role in vitiligo has not been well characterized.
Objective: To assess the clinical efficacy and tolerability of crisaborole 2% ointment as monotherapy in inducing repigmentation in segmental stable vitiligo unresponsive to prior treatment.
Methods: A prospective, open-label interventional study was conducted involving 12 patients (8 females, 4 males; mean age 23.6 ± 5.1 years) with segmental stable vitiligo for at least 12 months. All participants had shown minimal or no response to previous topical corticosteroids and/or calcineurin inhibitors and had no new lesions in the past year.
Crisaborole 2% ointment was applied twice daily to affected areas for 16 weeks. Clinical evaluation was performed at baseline and every 4 weeks using:
- Vitiligo Area Scoring Index (VASI)
- Physician Global Assessment (PGA)
- Standardized digital photography
Adverse events and patient satisfaction were documented at each visit.
Results: Progressive perifollicular repigmentation was observed from week 8 onwards in most patients. At week 16:
- 83% (10/12) achieved >50% repigmentation
- 50% (6/12) achieved >75% repigmentation
- Mean VASI reduction: 62.4 ± 11.2% (p < 0.01)
- PGA: “marked improvement” in 75% of cases
Facial and truncal lesions responded more rapidly than acral lesions. Side effects were mild and transient, including short-lasting erythema and burning in 2 patients during the initial week. No systemic or pigmentary adverse events were recorded. Overall patient satisfaction was high, with 11 of 12 patients (92%) reporting significant improvement in confidence and willingness to continue treatment.
Conclusion: Crisaborole 2% ointment demonstrated notable efficacy and safety in achieving repigmentation in segmental stable vitiligo refractory to conventional therapy. By attenuating local inflammatory mediators through PDE4 inhibition, crisaborole may create a permissive microenvironment for melanocyte regeneration and pigment spread. Its non-steroidal nature, excellent tolerability, and ease of use make it a promising addition to the therapeutic armamentarium for localized vitiligo. Larger randomized studies are encouraged to validate these findings and explore its synergistic potential with phototherapy or surgical repigmentation methods.
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