Topical corticosteroids represent the first-line therapy for localized vitiligo, and are highly recommended for facial or small lesions and for use in children. Advantages include ease of application, high compliance rate, and low cost. Compared with PUVA, which promotes a predominantly perifollicular pattern of repigmentation, topical corticosteroids result in more diffuse repigmentation, which occurs more quickly but is less stable.62 Light and electron microscopy of skin biopsies from control and steroid-treated areas showed marked repopulation by functional melanocytes in the repigmented vitiliginous skin. In steroid repigmented areas melanocytes appeared dendritic and DOPA-positive, and unlike melanocytes in the pigment margins of untreated areas of vitiligo, contain many melanosomes of normal size and shape.63 The current trend, based on the results of a large meta-analysis that included randomized controlled trials of 29 patient series, is that class 3 and 4 corticosteroids are the most effective for treatment for localized vitiligo.52 Thus, localized lesions can be treated with a high-potency fluorinated corticosteroid (e.g., clobetasol propionate ointment, 0.05%) for 1–2 months. Treatment can be gradually tapered to a lower potency corticosteroid (e.g., hydrocortisone butyrate cream, 0.1%). Caution is necessary when using topical steroids on and around the eyelids, as their use can increase intraocular pressure and exacerbate glaucoma. Vitiligo recurrence after cessation of treatment and corticosteroid-induced side effects (i.e., skin atrophy, telangiectases, striae, and, rarely, contact dermatitis) are the limiting factors. Combination therapy (corticosteroids + UVB, corticosteroids + calcineurin inhibitors, corticosteroids + vitamin D analogs) may be beneficial in some cases, as two agents together may act synergistically on pigment restoration and on immune suppression, at lower individual doses, thus, potentially minimizing overall side effects.