Childhood vitiligo : Response to methylprednisolone oral minipulse therapy and topical fluticasone combination

Abstract

Background:Childhood vitiligo is always a challenge to treat, especially when the disease is progressing rapidly in such a patient. Oral minipulse with betamethasone has been tried in childhood vitiligo and also in some other immune mediated skin disorders with good results.Aims:The aim of the present study was to see the overall efficacy of methylprednisolone oral minipulse therapy in combination with topical fluticasone in progressive childhood vitiligo. The combination was tried to achieve a significant amount of repigmentation of vitiligo lesions already present at the initial visit.Materials and Methods:Four hundred children with progressive vitiligo were enrolled for this study and were prescribed oral methylprednisolone on two consecutive days every week in a minipulse form for a period of six months. In addition, the patients were instructed to apply fluticasone ointment topically once a day on their vitiligo lesions. The patients were assessed for the remission achieved as well as the extent of repigmentation of their already existent lesions.Results:More than 90% of patients went into complete remission after the start of the therapy. Moreover, about 65% (two-thirds) of patients achieved good to excellent repigmentation of lesions at the end of six months of therapy. The therapy was also well tolerated and the side effects seen were almost negligible.Conclusions:Oral minipulse treatment with methylprednisolone is an effective treatment option for controlling the disease spread in childhood vitiligo and with the addition of topical fluticasone the extent of repigmentation achieved is also quite significant.

Relapse after methylprednisolone oral minipulse therapy in childhood vitiligo: A 12-month follow-up study

“…In this form of treatment, oral corticosteroids are given on two consecutive days every week with a 5-days rest between the two minipulses. [12–15] The dose of betamethasone that has been used in this form of therapy is 5 mg on each of the 2 days in adults[13] while as methylprednisolone is used in a dose of 0.8 mg/kg body weight (max 32 mg) on each day of the minipulse. [12] The treatment is thus continued in most cases for duration of 6 months after which the treatment is usually withdrawn.…”

“…[12–15] The dose of betamethasone that has been used in this form of therapy is 5 mg on each of the 2 days in adults[13] while as methylprednisolone is used in a dose of 0.8 mg/kg body weight (max 32 mg) on each day of the minipulse. [12] The treatment is thus continued in most cases for duration of 6 months after which the treatment is usually withdrawn. The treatment is advocated in patients with progressive patchy or generalized vitiligo and even in acrofacial vitiligo.…”

A Retrospective Study of Methylprednisolone Mini-Pulse Therapy Combined with Narrow-Band UVB in Non-Segmental Vitiligo

“…Another study reported the use of oral MPD (0.8 mg/kg, maximum dose of 32 mg) given on 2 consecutive days a week for 6 months in progressive childhood vitiligo [13]. Four hundred children were enrolled, and more than 90% of the children went into complete remission whereas 65% achieved good to excellent repigmentation.…”

Vitiligo Management- An Update

“…In a later study on childhood vitiligo, betamethasone was replaced by oral methylprednisolone and combined with topical fluticasone ointment on the vitiligo lesions. The disease was arrested in >90% of patients, and >65% of children achieved good to excellent (>50%) repigmentation of their vitiligo lesions 29 .…”

“…This has been further proved by the demonstration of receptors for 1 alphadihydroxyvitamin D3 on the melanocytes. These receptors are believed to have a role in stimulating melanogenesis 29 . Vitamin D analogues have given variable results in the treatment of vitiligo in different studies.…”