Combination Therapy with 308-nm Excimer Laser, Compound Glycyrrhizin, and Tacrolimus for Pediatric Facial and Cervical Vitiligo

Background: Vitiligo is a common acquired depigmenting disorder in pediatric dermatology. Facial and cervical involvement is particularly distressing due to cosmetic disfigurement, leading to psychosocial impairment in children and significant psychological burden for parents. Safe and effective treatment strategies to halt disease progression and promote repigmentation are urgently needed. Objective: To evaluate the clinical efficacy, onset of repigmentation, safety, and repigmentation patterns of 308-nm excimer laser combined with oral compound glycyrrhizin and topical 0.03% tacrolimus in children with facial and cervical vitiligo. Methods: A total of 112 pediatric patients were randomized into two groups: treatment group (n=56, 86 lesions) received oral compound glycyrrhizin, topical 0.03% tacrolimus, plus 308-nm excimer laser twice weekly for 16 weeks; control group (n=56, 78 lesions) received compound glycyrrhizin and tacrolimus only. Clinical efficacy, time to initial repigmentation, adverse events, and repigmentation patterns (marginal, follicular, mixed) were assessed. Results: The overall efficacy rate was significantly higher in the treatment group (89.53%) than in controls (70.51%) (p< 0.05). Initial repigmentation occurred earlier in the treatment group (face: 3.12± 0.45 weeks; neck: 3.74± 0.44 weeks) compared with controls (face: 4.08± 0.50 weeks; neck: 4.54± 0.51 weeks, both p< 0.05). Adverse events were rare (3.57%) and self-limited. Repigmentation patterns differed: treatment lesions showed predominantly mixed repigmentation (65.12%), whereas controls were mainly follicular (57.69%). Conclusion: Combination therapy with 308-nm excimer laser, compound glycyrrhizin, and 0.03% tacrolimus is safe and effective for pediatric facial and cervical vitiligo, providing faster repigmentation, higher efficacy, and distinct repigmentation patterns compared with medical therapy alone. Keywords: vitiligo, pediatric, excimer laser, tacrolimus, glycyrrhizin, repigmentation pattern