Oral minipulse therapy in vitiligo.

Dr. A.J. Kanwar, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, 60012 Chandigarh (India) Though various modalities of treatments are available for vitiligo, none is uniformly effective. Systemic corticosteroids have been used in the treatment of vitiligo presuming it to be autoimmune in nature [ 1 ]. In order to reduce the side-effects, it can be administered in ‘pulse’ form with beneficial effects [2]. ‘Oral minipulse’ (OMP) therapy implies use of cyclical pulse dose corticosteroids in much smaller doses compared to the usual pulse therapy. Therefore, the sideeffects are further minimized, and this therapy can be used by patients at home with regular follow-up at the clinic [3]. Recently Pasricha and Khaitan [4] tried corticosteroid OMP therapy in 40 vitiligo patients with encouraging results. We report herein our results with OMP in vitiligo. Thirty-seven patients (23 male, 14 female) with rapidly spreading vitiligo covering more than 2% body surface area were recruited. Their ages ranged from 6 to 46 years (mean 22.62 years), and the duration of disease varied from 1.5 months to 5 years (mean 1.81 years). Of 37 patients, 31 (83.8%) had vitiligo vulgaris, while 6 (16.2%) had segmental vitiligo. All patients were screened for any contraindication for systemic corticosteroids. A single dose of OMP in adults consisted of 10 tablets of dexamethasone (0.5 mg each) given on 2 consecutive days in a week after breakfast in the morning. In children ( < 16 years old) the dose was halved. A minimum of 5 doses and a maximum of 25 doses were tried. No other treatment was prescribed during the study period. The therapeutic response was graded as no response, weak, moderate, excellent response and total clearance. Patients were reviewed every 5 weeks by the senior author. Thirty-two (86.4%) patients completed the trial, while 5 (13.6%) defaulted. In 14 (43.8%) patients, new lesions stopped appearing and there was mild to moderate repigmentation, while in 18 (56.2%) there was no response (table 1). Patients who showed a response mostly showed repigmentation within the first 15 weeks (doses) of treatment. Patients with segmental vitiligo were worst