EFFICACY AND SAFETY OF ORAL DEXAMETHASONE PULSE TREATMENT FOR VITILIGO

Abstract

Background: Results of previous studies on efficacy and safety of oral corticosteroid pulse treatment for vitiligo are inconsistent. Objective: The objective of this study was to assess the efficacy and safety of oral dexamethasone pulse treatment in a cohort of Pakistani patients. This is a descriptive study. Patients and Methods: Thirty patients with vitiligo were included in the study. Of these, 21 had progressive disease and 9 had stable disease. The patients were given weekly pulses of dexamethasone on 2 consecutive days every week followed by 5 days off treatment for a maximum of 24 weeks. Clinical response and side effects were evaluated at monthly intervals. Plasma cortisol levels were also monitored. Results: After a mean treatment period of 16 + 4 weeks, progression was arrested in 18 (85.7%) of 21 patients with active vitiligo before the study. Overall, repigmentation was noted in 14 (46.6%) patients at the end of 24 weeks. The extent of repigmentation varied from less than 25% (slight) to 51% to 75% (marked). Twenty (66.6%) patients reported one or more side effects. Plasma cortisol values were markedly decreased 24 hours after the second dose of each pulse but returned to baseline before the next dexamethasone pulse. Conclusion: Oral corticosteroid pulse therapy is an effective treatment modality to arrest progressive vitiligo but is only moderately effective in inducing satisfactory repigmentation. Treatment associated side effects are frequent but reversible; however, sustained suppression of endogenous cortisol production does not occur with pulse regimen.