Background and Aims

Vitiligo, an acquired, multifactorial, autoimmune disorder is classified for therapeutic purposes as progressive and non-progressive. The first priority for the treatment of vitiligo should be to control the disease process, and then taking measures to re-pigment.

Methods

We had three different studies in patients with progressive vitiligo

Results

In progressive disease, there is continuous assault on melanocytes and modalities which do not arrest this process may not work. Corticosteroids suppress autoantibody formation and induces apoptosis of cytotoxic T cells. It helps not only in halting progression of the disease, but also induces re-pigmentation as normal melanocytes from the periphery of the lesions or perifollicular areas take over.

To achieve long-term safety of systemic corticosteroids, we used oral mini-pulse therapy (OMP) in 1993 and since then, most studies indicate that OMP halts disease progression in rapidly spreading vitiligo and induces variable re-pigmentation. To address the need for another immunosuppressant, we compared the efficacy and safety of betamethasone OMP vs oral azathioprine in arresting the disease progression and inducing re-pigmentation. In the OMP group arrest of progression was achieved earlier at 2 and 4 months compared to azathioprine at 6 months. Re-pigmentation was also better in OMP group.

Immunomodulatory effect of NB-UVB is by increasing regulatory T-lymphocytes and inhibiting the number of CD8+ T-lymphocytes. In our study, 19 out of 24 progressive vitiligo patients had halting of disease activity after 6 months of NB-UVB.

Conclusions

To conclude, oral corticosteroid as OMP, azathioprine and NB-UVB in various permutation and combination can be useful in progressive vitiligo.