Case of the Month

This 5 year old girl presented with an enlarging white spot on her face and chest/neck for the past 10 months

What's Your Diagnosis?

Diagnosis: Vitiligo

I treated her vitiligo treated with nbUVB (x62 treatments), tofacitinib cream, class 6 steroid cream, Dovonex cream, and Pimecrolimus.
5 month treatment period. (PWPP). Specifically: Morning: tofacitinib + Dovonex, After dinner: Class VI steroid, Bedtime: tofacitinib and pimecrolimus.
My nbUVB schedule is 2-3x/week.

You can treat without the narrow band UVB, but it takes longer and does not always fill in completely.
I had the tofacitinib compounded at: Custon Scripts Pharmacy 1 800 226 7094,
Since it is off label I have had patients sign a consent.

Since everyone is different I will start a gentle taper off of lights and topicals to see how she does. Some do fine and others need minimal or regular treatment to stay clear. I find it varies based on the patient.
I also acknowledge that not everyone can afford the treatments. If that is the case I offer the nbUVB at no charge or at a nominal rate ($1-2/tx - so the patients feel good about participation).

I am happy to report a protocol that works to treat vitiligo. Now we must fight for coverage!

I would encourage my colleagues to keep pressure on insurance companies and our professional organizations to have adequate coverage for this disturbingly difficult disease.

Here is another example of a boy treated with the same protocol. His mother asked for help with tears in her eyes because he was being bullied and did not want to go to school.