# Vitiligo (referral & initial topical management) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: BAD Guidelines for Vitiligo for the regimen, with the product and its application from Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939): "Apply thinly and gently rub in using only enough to cover the entire affected area once or twice a day until improvement occurs" and "If treatment with a local corticosteroid is clinically justified beyond 4 weeks, a less potent corticosteroid preparation should be considered." The SmPC carries no vitiligo indication and states no on-and-off cycling; that is from the BAD guideline, which is not held in this corpus. · BAD Guidelines for Vitiligo · Protopic 0.1% ointment SmPC sections 4.1-4.4 (eMC product 1608) · OPZELURA (ruxolitinib) cream 1.5% US prescribing information, boxed warning, section 1.2 Nonsegmental Vitiligo, section 2.2 Recommended Dosage and Administration for Nonsegmental Vitiligo and section 8.4 Pediatric Use (DailyMed SetID 24da5509-6631-4795-9d42-273faecd08e7) - Verified date: 2026-08 ## Verified against - BAD Guidelines for Vitiligo for the regimen, with the product and its application from Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939): "Apply thinly and gently rub in using only enough to cover the entire affected area once or twice a day until improvement occurs" and "If treatment with a local corticosteroid is clinically justified beyond 4 weeks, a less potent corticosteroid preparation should be considered." The SmPC carries no vitiligo indication and states no on-and-off cycling; that is from the BAD guideline, which is not held in this corpus. - BAD Guidelines for Vitiligo - Protopic 0.1% ointment SmPC sections 4.1-4.4 (eMC product 1608) - Vitiligo - disease-level clinical article (vitiligo-referral-clinical.txt) - OPZELURA (ruxolitinib) cream 1.5% US prescribing information, boxed warning, section 1.2 Nonsegmental Vitiligo, section 2.2 Recommended Dosage and Administration for Nonsegmental Vitiligo and section 8.4 Pediatric Use (DailyMed SetID 24da5509-6631-4795-9d42-273faecd08e7) - Vitiligo - disease-level clinical article (vitiligo-referral-full.txt) ## Treatment metadata - Clobetasol propionate — topical - Tacrolimus — topical - Referral & safety-netting (no drug therapy) - Ruxolitinib — topical ## Complete treatment card ```text VITILIGO (REFERRAL & INITIAL TOPICAL MANAGEMENT) Sources: BAD Guidelines for Vitiligo for the regimen, with the product and its application from Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939): "Apply thinly and gently rub in using only enough to cover the entire affected area once or twice a day until improvement occurs" and "If treatment with a local corticosteroid is clinically justified beyond 4 weeks, a less potent corticosteroid preparation should be considered." The SmPC carries no vitiligo indication and states no on-and-off cycling; that is from the BAD guideline, which is not held in this corpus. · BAD Guidelines for Vitiligo · Protopic 0.1% ointment SmPC sections 4.1-4.4 (eMC product 1608) · OPZELURA (ruxolitinib) cream 1.5% US prescribing information, boxed warning, section 1.2 Nonsegmental Vitiligo, section 2.2 Recommended Dosage and Administration for Nonsegmental Vitiligo and section 8.4 Pediatric Use (DailyMed SetID 24da5509-6631-4795-9d42-273faecd08e7) Review status: REVIEWED against BAD Guidelines for Vitiligo for the regimen, with the product and its application from Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939): "Apply thinly and gently rub in using only enough to cover the entire affected area once or twice a day until improvement occurs" and "If treatment with a local corticosteroid is clinically justified beyond 4 weeks, a less potent corticosteroid preparation should be considered." The SmPC carries no vitiligo indication and states no on-and-off cycling; that is from the BAD guideline, which is not held in this corpus., BAD Guidelines for Vitiligo, Protopic 0.1% ointment SmPC sections 4.1-4.4 (eMC product 1608), Vitiligo - disease-level clinical article (vitiligo-referral-clinical.txt), OPZELURA (ruxolitinib) cream 1.5% US prescribing information, boxed warning, section 1.2 Nonsegmental Vitiligo, section 2.2 Recommended Dosage and Administration for Nonsegmental Vitiligo and section 8.4 Pediatric Use (DailyMed SetID 24da5509-6631-4795-9d42-273faecd08e7), Vitiligo - disease-level clinical article (vitiligo-referral-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Onset can follow mechanical trauma, a severe sunburn, exposure to certain chemicals, or major emotional stress - A personal or family history of autoimmune disease, especially autoimmune thyroid disease, often accompanies it SIGNS - what you find (5) - Well-demarcated, milky or chalk-white patches level with the surrounding skin, without scale - Lesions favor the skin around the eyes, mouth, and genitals, the hands and feet, and friction areas like elbows and knees - New patches at sites of trauma or friction (Koebner phenomenon) occur in roughly 20 to 60 percent of patients and mark active disease - Depigmented hairs within a patch (leukotrichia) predict a poorer response to standard medical treatment - Exam should also look for a goiter and patches of hair loss suggesting alopecia areata [goitre · hair loss] TESTS (5) - Under a Wood lamp, patches glow bright blue-white, most useful in lighter skin tones - Dermoscopy can help tell whether disease is currently active or stable - Skin biopsy is not usually needed and is reserved for atypical or uncertain cases - Biopsy shows loss of melanocytes in the basal skin layer, confirmable with Melan-A or HMB-45 stains - VASI and F-VASI scoring tools quantify how much body surface area is depigmented IF NOT THIS - what else fits (10) - Congenital patches that stay stable over time and glow off-white rather than bright blue-white under Wood's lamp point to nevus depigmentosus - Lance-shaped patches from infancy, with seizures or facial angiofibromas, point to tuberous sclerosis rather than vitiligo - Ill-defined, finely scaly pale patches on a child's face suggest pityriasis alba, a mild form of eczema - Small pearly-white spots on sun-damaged skin of an older adult suggest idiopathic guttate hypomelanosis - Yellow-green fluorescence under Wood's lamp with a positive KOH test points to tinea versicolor instead - A pigmented mole ringed by depigmentation is a halo nevus, which can appear alongside vitiligo - Ill-defined trunk patches in young adults with red follicular dots under Wood's lamp suggest progressive macular hypomelanosis - A history of exposure to phenolic chemicals or drugs such as EGFR inhibitors suggests a chemical or drug cause - Hypopigmented patches with subtle scaling or thinning need biopsy to exclude mycosis fungoides - Partial, ill-defined pigment loss after eczema or psoriasis that gradually fades points away from vitiligo's complete, fixed depigmentation Source StatPearls "Vitiligo" - disease-level clinical article Status traced to the source above Rx: Body and limbs | Face and flexures | Main treatment | Topical JAK inhibitor for non- segmental vitiligo, especially facial - dermatology-initiated BODY AND LIMBS 1. CLOBETASOL PROPIONATE [1st line] Adult Apply 0.05% cream thin layer once daily to non-facial depigmented macules for 4 weeks on, 4 weeks off (max 12 weeks total) x 4-12 weeks (intermittent) Peds Avoid potent topical steroids in children under 1 year; use mild/moderate topical steroids under specialist care Source BAD Guidelines for Vitiligo for the regimen, with the product and its application from Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939): "Apply thinly and gently rub in using only enough to cover the entire affected area once or twice a day until improvement occurs" and "If treatment with a local corticosteroid is clinically justified beyond 4 weeks, a less potent corticosteroid preparation should be considered." The SmPC carries no vitiligo indication and states no on-and-off cycling; that is from the BAD guideline, which is not held in this corpus. Why Potent topical corticosteroid that dampens the autoimmune destruction of melanocytes; used as initial non-facial treatment to attempt repigmentation of vitiligo macules while awaiting specialist referral. Caution Do NOT apply to face, intertriginous areas, or flexures (risk of rapid skin atrophy, striae, and telangiectasia). Limit application to <10% body surface area to prevent systemic absorption and HPA axis suppression. Egypt CLOBITAT 0.05% TOPICAL CREAM 15 GM BIORIGINAL INTERNATIONAL GROUP PHARMA... 5.50 EGP DERMASOL 0.05% CREAM 20 GM UP PHARMA 5.50 EGP DERMASOL 0.05% OINT. 20 GM UP PHARMA 5.50 EGP CLEROVATE 0.05% TOPICAL OINT. 25 GM MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 7.50 EGP CLOVACORT 0.05% OINT. 20 GM EUROPEAN EGYP... 9.00 EGP DERMOPHARM 0.05% CREAM 25 GM WESTERN PHARM... 22.00 EGP DERMOVATE 0.05% TOP. CREAM 25 GM GLAXO SMITHKLINE 44.00 EGP HEROBETASOL 120 MLSHAMPOO EGPI > HEROPHARM 37.50 EGP FACE AND FLEXURES 2. TACROLIMUS [1st line] Adult Apply 0.1% ointment thin layer twice daily to facial and neck depigmented lesions x 6-12 months Peds Age restriction: minimum 24 months 2 to 16 years: The 0.03% strength only, never 0.1%. Not used under 2 years. (2 to 16 years: the 0.03% strength only, never 0.1%. Under 2 years it is not used.) Source Protopic 0.1% ointment SmPC sections 4.1-4.4 (eMC product 1608) Why Topical calcineurin inhibitor preferred for delicate facial and intertriginous vitiligo without steroid atrophy risk Caution Transient application site burning, itching, and erythema are common during the first week. Avoid continuous sun exposure or phototherapy without physician supervision. Avoid application on active cutaneous infections. Vitiligo is off-label. The licence is for moderate to severe atopic dermatitis that has not answered conventional treatment - nothing else. 0.1% is for 16 and over. A child aged 2 to 16 gets the 0.03% strength, and under 2 it is not used at all. Keep the treated skin out of the sun, and no sunbeds, UVB or PUVA alongside it. In vitiligo this cuts both ways: the patch has no melanin to protect it and the drug adds its own concern about UV. Not onto skin that is clinically infected - treat the infection first. Egypt TAROLIMUS 0.1% TOPICAL OINT. 15 GM ANDALOUS PHARMA 144.00 EGP TRECZIMUS 0.1% TOPICAL OINT. 30 GM MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 219.00 EGP PROTOPIC 0.1 % OINT. 30 GM LEO PHARMACEU... 407.00 EGP TRECZIMUS 0.03% TOPICAL OINT. 20 GM MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 114.00 EGP TAROLIMUS 0.03% TOPICAL OINT. 15 GM ANDALOUS PHARMA 129.00 EGP PROTOPIC 0.03 % OINT. 30 GM LEO PHARMACEU... 371.00 EGP MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Vitiligo - disease-level clinical article (vitiligo-referral-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - There is a high risk of associated systemic autoimmune disorders (autoimmune thyroiditis/Hashimoto, pernicious anemia, T1DM, alopecia areata), requiring clinical screening. RED FLAG - Ocular and auditory complications can occur (uveitis, chorioretinal abnormalities, sensorineural hearing loss). TOPICAL JAK INHIBITOR FOR NON-SEGMENTAL VITILIGO, ESPECIALLY FACIAL - DERMATOLOGY-INITIATED 4. RUXOLITINIB [2nd line] Adult A thin layer twice a day, with a hard ceiling on how much skin and how much cream. US label verbatim: "Instruct patients to apply a thin layer of OPZELURA twice daily to affected areas of up to 10% body surface area." and "Do not use more than one 60 gram tube of OPZELURA per week or one 100 gram tube per 2 weeks." The strength is 1.5%, which is what the disease article also names. It is "for topical use only" and "not for ophthalmic, oral, or intravaginal use." - Months, and the label says so rather than leaving it open. US label verbatim: "Satisfactory patient response may require treatment with OPZELURA for more than 24 weeks. If the patient does not find the repigmentation meaningful by 24 weeks, the patient should be re-evaluated by the healthcare provider." Peds Age restriction: minimum 144 months 12 years and over: The same strength and the same twice-daily application as an adult. The 10% body-surface-area and 60 g per week limits apply too. (Licensed from 12 years in this disease, at the same strength and the same twice-daily application. US label verbatim: "The safety and effectiveness of OPZELURA for the topical treatment of nonsegmental vitiligo have been established in pediatric patients ages 12 years and older." and "The safety and effectiveness of OPZELURA have not been established in pediatric patients younger than 12 years of age with nonsegmental vitiligo." The 10% body-surface-area and 60 g per week limits apply to adolescents too.) Source OPZELURA (ruxolitinib) cream 1.5% US prescribing information, boxed warning, section 1.2 Nonsegmental Vitiligo, section 2.2 Recommended Dosage and Administration for Nonsegmental Vitiligo and section 8.4 Pediatric Use (DailyMed SetID 24da5509-6631-4795-9d42-273faecd08e7) Why The disease article names the drug and the strength, verbatim: "Topical JAK inhibitors (eg, ruxolitinib 1.5%): Effective, especially for facial vitiligo" and adds "Topical JAK inhibitors (eg, ruxolitinib) are well tolerated, with mild local reactions or acneiform eruptions." The US label's indication section names the disease, verbatim: "OPZELURA is indicated for the topical treatment of nonsegmental vitiligo in adult and pediatric patients 12 years of age and older." The card carried a potent steroid and a calcineurin inhibitor, which is where the article puts the first line; this is the drug it names next, and the one licensed for the disease itself. Egypt registers a matching product - RUXOTOP 1.5% cream 60 g, filed under the drug class VITILIGO, at about 3,210 EGP a tube - so the cost of the 60 g weekly ceiling is a real conversation to have before starting. Caution RED FLAG - boxed warning, and it is the oral JAK inhibitor class warning carried onto a cream. US label verbatim: "WARNING: SERIOUS INFECTIONS, MORTALITY, MALIGNANCY, MAJOR ADVERSE CARDIOVASCULAR EVENTS, AND THROMBOSIS." On infection: "Avoid use of OPZELURA in patients with an active, serious infection, including localized infections. If a serious infection develops, interrupt OPZELURA until the infection is controlled." Tuberculosis and herpes zoster are named. Latent tuberculosis is common in Egypt. Malignancy and cardiovascular events, verbatim from the same boxed warning: "Malignancies were reported in patients treated with OPZELURA. Lymphoma and other malignancies have been observed in patients receiving JAK inhibitors used to treat inflammatory conditions." and "Discontinue OPZELURA in patients who have experienced a myocardial infarction or stroke." and "Thromboembolic events were observed in trials with OPZELURA... Avoid OPZELURA in patients at risk." Current and former smokers are named as being at additional risk. The two limits are the safety mechanism, not packaging advice. Ten per cent of body surface area and one 60 g tube a week are what keep systemic absorption low; a patient with widespread vitiligo who treats everything at once is taking a systemic JAK inhibitor by another route. Not to be combined with the other immunosuppressants. US label verbatim: "Use of OPZELURA in combination with therapeutic biologics, other Janus kinase (JAK) inhibitors, or potent immunosuppressants such as azathioprine or cyclosporine is not recommended." Vitiligo repigmentation is slow and sun protection stays part of the treatment. Twenty- four weeks is the label's own review point, and depigmented skin burns. Do not confuse it with the oral drug. JAKAVI (ruxolitinib) tablets on the Egyptian register are a systemic antineoplastic JAK inhibitor for myelofibrosis and polycythaemia, priced in the tens of thousands of pounds; what is prescribed here is a 1.5% cream. They share an ingredient name and nothing else. Egypt RUXOTOP 1.5% CREAM 60 GM MARCYRL 3210.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)