Oral Therapy & Narrow-Band UVB

Lee and associates (2016) noted that systemic corticosteroids have been used to arrest the progression of vitiligo; however, side effects have been a constant issue.  In a retrospective study, these researchers examined the efficacy and side effect of oral mini-pulse (OMP) therapy with methylprednisolone (MPD) combined with narrow-band ultraviolet B (NB-UVB) for adults with non-segmental vitiligo.  A total of 32 patients with extensive and/or spreading vitiligo received 0.5 mg/kg MPD on 2 consecutive days per week with NB-UVB therapy for at least 3 months.  All subjects (100 %) showed progression arrest within 12 weeks; 19 out of 32 patients (59.4 %) exhibited re-pigmentation on more than 25 % of lesions; 13 patients (40.6 %) attained satisfactory re-pigmentation in more than 50 % of lesions.  Only 2 patients discontinued the medication due to gastro-intestinal (GI) trouble.  The authors concluded that OMP therapy with MPD combined with NB-UVB appeared effective in arresting vitiligo progression and rapidly inducing re-pigmentation with minimal side effects.  This was a retrospective study with a relatively small (n = 32) sample size, and short-term follow-up (12 weeks); its findings need to be validated by well-designed studies with larger sample sizes and longer follow-up.

Dellatorre and co-workers (2020) noted that the prevalence of vitiligo in Brazil was determined to be 0.54 %.  There is no on-label medication for its treatment. To-date, no Brazilian consensus on the treatment of vitiligo had been written.  The objective of this group of Brazilian dermatologists with experience in the treatment of vitiligo was to reach a consensus on the clinical and surgical treatment of this disease, based on articles with the best scientific evidence.  A total of 7 dermatologists were invited, and each was assigned 2 treatment modalities to review.  Each treatment (topical, systemic, and phototherapy) was reviewed by 3 experts; 2 experts reviewed the surgical treatment.  Subsequently, the coordinator compiled the different versions and drafted a text regarding each type of treatment.  The new version was returned to all experts, who expressed their opinions and made suggestions for clarity.  The final text was written by the coordinator and sent to all participants to prepare for the final consensus.  The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid mini-pulse in progressive generalized vitiligo; NB-UVB for extensive forms of the disease.  Surgical modalities are indicated for segmental and stable generalized vitiligo.  Topical and systemic anti-JAK drugs are being tested, with promising results.  Moreover, these researchers stated that the OMP regimen can be combined with phototherapy in patients with progressive vitiligo, although controlled studies with long-term follow-up are still needed.