ORAL MINI-PULSE THERAPY WITH BETAMETHASONE IN VITILIGO PATIENTS HAVING EXTENSIVE OR FAST-SPREADING DISEASE

Background. Systemic corticosteroids can arrest the progression of vit iligo and lead to repigmentation in a significant proportion of patien ts, but may also produce unacceptable side effects. To minimize the si de effects, we tried a new approach using mini-pulse therapy with beta methasone. Methods. Forty patients having extensive and/or fast-spread ing vitiligo were given 5 mg betamethasone/dexamethasone as a single o ral dose after breakfast on 2 consecutive days per week. The response to treatment was evaluated by photographs taken every 2-4 months and r ecording the side effects. Results. Within 1-3 months, progression of the disease was arrested in 89% of the 36 patients having active disea se, while 2 patients needed an increase in the dose to 7.5 mg per day to achieve complete arrest of lesions. Within 2-4 months, 80% of the p atients started having spontaneous repigmentation of the existing lesi ons which progressed with continued treatment. The extent of repigment ation varied in different patients and even in different lesions in th e same patient. It was less than 10% in 14 (35%) patients and almost c omplete (>90%) in three patients. The side effects included weight gai n of 5 and 7 kg in two patients, mild headache in two patients, transi tory general weakness for 2 days after the pulse in two patients, and bad taste in the mouth in three patients; 23 patients, including six c hildren, had no side effects. Conclusions. Oral mini-pulse therapy wit h betamethasone/dexamethesone seems to be an effective treatment modal ity to arrest the progression of vitiligo. It also induces spontaneous repigmentation. It deserves to be tried on a large scale to evaluate its advantages over the currently available methods of treatment.