What is the recommended initial approach to treating vitiligo?

The recommended initial approach to treating vitiligo involves the use of topical corticosteroids or calcineurin inhibitors. This treatment option is favored because it targets the localized areas of depigmentation without the side effects associated with systemic treatments. Topical corticosteroids help reduce inflammation and can promote repigmentation in some patients, making them a first-line option.

Calcineurin inhibitors, such as tacrolimus or pimecrolimus, are also effective, particularly in sensitive areas like the face and neck, where the risks of steroid use might be more concerning. These drugs provide a steroid-sparing effect while effectively managing the immune response that contributes to vitiligo.

In contrast, other treatments listed may not be the first choice for managing this condition. Phototherapy is often reserved for cases where topical treatments do not yield satisfactory results, making it a secondary option rather than an initial approach. Systemic immunosuppressants and oral corticosteroids are generally not recommended as first-line treatments for vitiligo due to their broader systemic effects and potential for significant side effects. Thus, starting with appropriate topical treatments allows for a more targeted and safer management of vitiligo at its onset.