Tailoring Pediatric Vitiligo Treatment: Insights from SPD 2026

As treatment options for pediatric vitiligo continue to expand, dermatologists are increasingly able to tailor therapy based on disease extent, activity, and patient-specific factors. At the 2026 Society for Pediatric Dermatology (SPD) Annual Meeting in Minneapolis, Minnesota, Nanette Silverberg, MD, chief of pediatric dermatology and clinical professor of dermatology and pediatrics at the Icahn School of Medicine at Mount Sinai, presented an update on managing widespread and challenging cases of vitiligo, drawing on recent research and evolving consensus guidelines.

Silverberg’s session synthesized findings from multiple research initiatives conducted at Mount Sinai and through collaborations with the Pediatric Dermatology Research Alliance (PeDRA) and the International Disorders of Pigmentation Association (IDPA). Her talk emphasizes her approach to evidence-based treatment, rooted in shared decision-making and individualized assessment. Initial evaluation begins with determining disease severity and activity. In addition to assessing body surface area involvement, clinicians should identify markers of rapidly progressive disease, including the Koebner phenomenon, confetti-like depigmentation, and trichrome lesions. Facial involvement also warrants particular attention, as studies have demonstrated that patients perceive facial disease as substantially more impactful than lesions elsewhere on the body, making facial repigmentation a primary treatment goal.

“It's been demonstrated that patients see the face as 8 times more consequential than other parts of the body. So we really do concentrate first on clearing the face,” she said.

Silverberg highlighted the 2024 pediatric vitiligo consensus guidelines published in JAMA Dermatology, which characterize vitiligo as a chronic, relapsing inflammatory disease and provide recommendations for diagnosis and topical management. The guidelines identify 3 evidence-supported topical therapies: topical corticosteroids, topical calcineurin inhibitors, and topical ruxolitinib 1.5% cream, the first FDA-approved treatment for nonsegmental vitiligo. For patients with involvement of 10% body surface area or less, these topical therapies can often achieve meaningful repigmentation when used appropriately.

For more extensive or unstable disease, topical therapy may be supplemented with systemic interventions designed to rapidly halt progression. Silverberg discussed the use of short courses of systemic corticosteroids, as well as emerging evidence supporting agents such as minocycline in selected patients. Although oral Janus kinase (JAK) inhibitors remain off-label in pediatric vitiligo, she noted that additional clinical data are accumulating and regulatory approvals for adolescents may be forthcoming in the coming years. 

Phototherapy also remains a cornerstone of treatment. Narrowband UVB continues to demonstrate robust efficacy for both widespread and segmental vitiligo, and increasing insurance coverage for home phototherapy units has expanded access for many families. Silverberg also discussed distinctions between nonsegmental and segmental vitiligo, drawing on data from a multicenter registry developed in collaboration with investigators at Northwestern University. Although segmental vitiligo is typically localized, it often progresses rapidly within the affected region, requiring prompt intervention to maximize repigmentation. 

Dermatology Times is on-site in Minneapolis covering SPD’s latest updates from July 22 to 25th; view all our live conference coverage here. To keep up with all the exciting interviews, posters, and news, be sure to subscribe here and follow us on social media for more.