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Background:Topical corticosteroids are used as first line of therapy for vitiligo, although side effects such as adrenal insufficiency are possible.Objectives:To establish the role of ACTH test before, during, and after treatment with high potency topical steroids; to determine if adrenal insufficiency occurs secondary to the use of high potency topical steroids in patients with vitiligo and intact cutaneous barrier; and also to determine response to treatment and side effects.Materials and Methods:Forty-four adults with non-segmental vitiligo affecting 20% or less of the body surface area were included and randomized to receive topical clobetasol propionate 0.05% cream (group 1) or placebo (group 2) for 12 weeks, with a maximum dose of 50 g per week. The placebo group was crossed over after week 6 and started on clobetasol until completion of the study. Serum cortisol levels with the 1 μg ACTH test were determined at baseline and on weeks 6 and 12.Results:No adrenal insufficiency was detected nor statistical significance was achieved when comparing cortisol levels between and within the groups at baseline and weeks 6 and 12. Group 1 had a better response to therapy but with more side effects.Conclusions:Doses of 50 g or less per week of clobetasol during a period of 12 weeks are safe on adult vitiligo patients, although local side effects are possible. Repigmentation rates were incomplete with single steroid therapy, making combined therapy a better option.

Immunotherapy for resistant and/or severe alopecia areata in a university hospital setting in Northern MexicoAlopecia areata causes non-scarring alopecia usually involving the scalp; however, it can affect any part of the body. It can start at any age, with no gender predominance. [1][2][3] Its aetiology is autoimmune, mediated by TCD8+ lymphocytes. Severe forms are usually chronic and recurrent. [1][2][3][4] Multiple treatments have been described including topical and intralesional steroids, 3,5-7 topical immunotherapy 3,5,8 and inhibitors of the JAK pathway (tofacitinib), 6,7 all with variable results. 3,[5][6][7] For extensive or resistant cases, immunotherapy with squaric acid dibutylester (SADBE) and diphenylcyclopropenone (DPCP) remains a first-line alternative; however, reports on the use of this therapeutic option are scarce in Latin America. Its mechanism of action is unknown, although it is believed to induce antigenic competition by attracting cd4+T cells to the peribulbar region, changing the cd4+/cd8+T lymphocyte ratio. 5,7 Response rates to immunotherapy are varied within the literature, ranging from 4 to 87%. 5 A recent meta-analysis of 2227 patients reported a general growth of any amount of hair in 65.5% patients and complete regrowth in 32.3% with a relapse rate of 38.3% among patients with maintenance therapy and 49% in those without it. 8

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