Vitiligo is an acquired disorder of skin depigmentation present in roughly 1% of the population which can be psychologically devastating, particularly in children and patients with skin of color. It is an autoimmune disease of T-cell mediated melanocyte destruction that cannot be cured but can be managed to promote repigmentation. There have been few reports on real-world prescribing practices for vitiligo. Information is especially scarce when it comes to pediatric patients under 18 years of age. Prior work suggests management of vitiligo in children does not uniformly approach the current standard of care, which may relate to concerns regarding safety and practicality but also limited insurance coverage and other barriers to access.
Currently, first-line treatments for vitiligo in young patients include topical calcineurin inhibitors (TCIs), topical corticosteroids, and phototherapies (narrowband UVB and excimer laser). Second-line or other off-label treatments for vitiligo include systemic corticosteroids, immunomodulators such as methotrexate, and oral Janus kinase (JAK) inhibitors. The topical JAK inhibitor ruxolitinib was approved in 2022 for use in patients over 12 years with vitiligo and is the first and only FDA-approved therapeutic for repigmentation in vitiligo to date. Prior to the introduction of ruxolitinib, one study found TCIs are not universally covered for vitiligo by health insurance in the United States, though they are consensus first line management. With the introduction of novel therapeutics, further investigation of undertreatment is warranted, particularly in pediatric patients who have more limited approved options.
Narrowband UVB phototherapy (nbUVB) is also first line in the management of vitiligo, particularly for widespread or rapidly progressing disease, demonstrating successful repigmentation and no increased risk of skin cancer in adult patients. For actively depigmenting disease, international consensus guidelines for the treatment of vitiligo in adults recommends a combination of topical therapy (corticosteroid and/or immunomodulators) and nbUVB. Increasing data suggests combination phototherapy and topical therapy achieves maximal repigmentation particularly for facial involvement. However, phototherapy is not always used in children, and access appears variable though not well studied. Few studies of nbUVB specifically include children; when included, it is most often with vitiligo as one of multiple inflammatory skin diseases assessed and a minority of subjects.
Aim 1: Describe the proportion of the utilization of nbUVB and topical medication in pediatric vitiligo.
Aim 2: To compare the proportion of the utilization of nbUVB and topical medications for vitiligo with those for atopic dermatitis (AD), another prevalent skin disorder in children.