Oral dexamethasone pulse treatment for vitiligo

Background: Oral corticosteroid pulse therapy has provided inconsistent res ults in the treatment of Indian patients with vitiligo. Objective: We wanted to evaluate the efficacy, safety, and tolerability of oral dexamethasone pulse therapy in a cohort of Austrian patients with viti ligo. Methods: Twenty-nine patients with vitiligo mere included in the study. Of these, 25 had progressive and 4 had stable disease. The patients were given weekly pulses of 10 mg dexamethasone each on 2 consecutive days followed b y 5 days off treatment for a maximum period of 24 weeks. Clinical response and side effects were evaluated in monthly intervals. Plasma cortisol and c orticotropin levels were monitored before and up to 6 days after the dexame thasone pulse in the first and fourth week of treatment: in 14 patients. Results: After a mean treatment period of 18.2 +/- 5.2 weeks, the disease a ctivity was arrested in 22 of 25 patients (88%) who had active vitiligo bef ore the study. Marked repigmentation occurred in 2 patients (6.9%) and mode rate or slight repigmentation in 3 patients (10.3%) each. No response was n oted in 21 patients (72.4%). Side effects were recorded in 20 patients (69% ) and included weight gain,insomnia, acne, agitation, menstrual disturbance , and hypertrichosis. Plasma cortisol and corticotropin values mere markedl y decreased 24 hours after the second dexamethasone dose, yet returned to b aseline values within the off treatment period before the next dexamethason e pulse. Conclusion: Our data show that oral dexamethasone pulse treatment is effect ive in arresting progression of vitiligo yet fails to induce satisfactory r epigmentation in the great majority of our patient cohort. Mild to moderate side effects are common with this treatment modality; however, sustained s uppression of endogenous cortisol production does not occur with the pulse regimen.