| Topical Therapy |
| Hydroquinone | Inhibit melanin production | 4% hydroquinone cream; apply BID | Skin irritation, allergic skin reaction, ochronosis | None | III1 |
| Tacrolimus | Anti-inflammatory | 0.1% ointment; apply BID 0.03% ointment; apply QD | Burning sensation of skin | None | IV2-5 |
| Corticosteroid | Anti-inflammatory | Superpotent: Halobetasol 0.05% cream/ointment; apply QD Midpotent: Triamcinolone 0.1% cream/ointment; apply QD | Skin irritation, hypopigmentation, skin atrophy | None | IV1,4,6,7 |
| Selenium sulfide | Cytostatic | 2.5% lotion; apply QD and rinse after 2 min | Skin irritation | None | IV6 |
| Systemic Therapy |
| Clofazimine | Anti-inflammatory, antimicrobial | <40 kg: 100 mg on alternating days, then 200 mg/wk; >40 kg: 100 mg QD 3 mo, then 400 mg/wk | Skin discoloration, GI adverse effects, GI upset | LFTs, Cr (baseline and quarterly) | IIB8 |
| Dapsone | Anti-inflammatory, antimicrobial | 100 mg QD | Fever, headache, GI upset, photosensitivity, agranulocytosos, hemolytic anemia in G6PD deficiency, Hypersensitivity syndrome | G6PD (prior to start), CBC (weekly for first month, monthly for 6 mo, then biannual), LFTs (baseline and quarterly) | IV9-11 |
| Isotretinoin | Anti-inflammatory | Low dose: 10-20 mg QD Taper: 40 mg QD 1 mo, 20 mg QD 2-3 mo, 10 mg QD 1 mo | Teratogenic, skin dryness, nausea, increased lipids and liver enzymes | ALT, triglycerides (prior to start, then repeat once after on full treatment daily dose), pregnancy test (in the United States.) (2 negative tests prior to start, then monthly) | IV7,12 |
| Corticosteroid | Anti-inflammatory | Prednisone taper 10-60 mg QD | Cushingoid appearance, hypertension, weight gain, GI upset, infection, osteoporosis, psychiatric disturbance, adrenal suppression, skin atrophy/hyperpigmentation | BP, weight, glucose, electrolytes (baseline and quarterly) | IV1,7,13 |
| Griseofulvin | Anti-inflammatory, fungistatic | 500-1000 mg QD | Rash, urticaria, peripheral neuropathy, photosensitivity, hepatotoxicity, granulocytopenia | BUN/Cr, CBC, LFTs (baseline and quarterly) | IV14 |
| Procedural Therapy |
| Narrowband UVB phototherapy | Anti-inflammatory | 2-3 wk minimum 24 sessions total, increase by 10%-15% per session | Skin irritation, PIH, blistering | None | IV4,15,16 |
| 1,550-nm erbium-doped fiber laser | Ablative | 15 mm spot, 400-525 µm depth, 4.65-4.91 kJ per session | Skin irritation, PIH, blistering | None | IV5 |