Steroids are effective in treating vitiligo, reducing the destruction of melanocytes, and promoting their repopulation and pigment production. Acting as both anti-inflammatory and immunosuppressant agents, steroids counteract the underlying pathophysiological mechanisms of the disease. Topical steroids have been successfully used to treat localized types of vitiligo. However, systemic steroid therapy is generally limited due to the potential for long-term side effects. In the following article, we will discuss the role of systemic steroids in the treatment of vitiligo.
Low-dose and mini-pulse steroid regimens have shown favorable outcomes, halting disease progression and promoting repigmentation. Intralesional steroids have also been used in selected cases with good results.
Indication of systemic steroids in vitiligo
- Rapidly progressive vitiligo (Active vitiligo)
The aim
- Control of disease progression.
- Repigmentation.
The types of steroids (other than topical) used to treat vitiligo
Oral steroids
- Oral dexamethasone
- Oral Methylprednisone
- Oral betamethasone
- Oral prednisone
Injectable steroids
- Betamethasone sodium phosphate and betamethasone dipropionate (IM).
- Methylprednisone (IV).
- Triamcinolone acetonide (intralesional)
The regimens used to treat vitiligo
Mini-pulse therapy
- Oral dexamethasone at a dosage of 5-7.5 mg per day for two consecutive days each week for a period of 3 to 6 months, or
- Oral betamethasone at a dosage of 5 -7.5 mg daily on two consecutive days per week for several months.
- Oral dexamethasone at a dosage of 2.5-3.5 mg per day after breakfast for two consecutive days each week for a period of 3 to 6 months.
- Betamethasone at a dose of 0.1 mg/kg twice weekly on two consecutive days, followed by 1 mg every month for the following three months.
- Methylprednisone at a dose of 0.5 mg per kilogram body weight, for two consecutive days each week for a period of 3 to 6 months.
Intravenous pulse therapy
- Methylprednisolone administered for three consecutive days at a dose of 8 mg/kg of body weight. The treatment was repeated at 4 and 8 weeks if tolerated.
Low dose prednisone
A low dose of oral prednisone, typically 0.3 mg per kg daily, may be considered a treatment option for adult progressive vitiligo for 1-3 months. If there is no evidence of disease progression, the prednisone dose should be gradually reduced by 5 mg every 2-4 weeks until the dose is 5 mg of prednisone every other day. (Ref)
Intralesional steroid treatment
Intralesional steroid (ILS) injection has been deemed a safe and uncomplicated therapeutic approach for vitiligo, provided that it is utilized prudently. Research has indicated that the combination of ILS injections with narrowband ultraviolet B (NB-UVB) radiation can be a useful approach in stimulating repigmentation in vitiligo patients, with observable outcomes manifesting in as short a period as 3 weeks and with a low occurrence of adverse effects.
The targeted patch is injected with triamcinolone acetonide concentration (0.625 mg/ml) diluted with normal saline. The volume of injection ranged from 0.5 to 1 ml depending on the size of the patch. The injection was given intradermally once a month for six months. Reported side effects include pain and skin atrophy. (Ref)
Role of systemic steroids in the Treatment of Pediatric Vitiligo
The systemic administration of corticosteroids, such as betamethasone and methylprednisolone can be used as an option in the treatment of active vitiligo. These medications have been shown to be effective in halting the progression of the disease and inducing repigmentation. Due to the potential for side effects, corticosteroids are typically administered for a short period, or in a pulsed regimen.
The dosages of corticosteroids are determined based on the patient’s characteristics. Recently, oral mini-pulse therapy (OMP) has been proposed as a treatment option for vitiligo. This therapy involves taking betamethasone (0.1 mg/kg body weight) on two consecutive days per week for 12 weeks, followed by a maintenance dose of 1 mg/month for the next three months. Clinical results have shown promise, with minimal risk of side effects. (Ref)
Another regimen has been used effectively in combination with topical steroids, methylprednisolone oral mini pulse therapy (0.8 mg/kg body weight) on two consecutive days every week. (Ref)
Possible side effects of systemic corticosteroids in vitiligo patients
- Weight gain.
- Difficulty sleeping.
- Restlessness.
- Hypertension.
- Skin problems such as acne.
- Irregular menstruation.
- Hypertrichosis.
Precautions
It is recommended that patients taking systemic corticosteroids be monitored by checking their glucose levels, weight, blood pressure, waist circumference, and any signs of infections. Additionally, an ocular examination should be performed every 6-12 months.
Systemic corticosteroid regimens are usually combined with other treatment modalities such as phototherapy.