Vitiligo Treatment: Oral Mini-Pulsed-Therapy (Steroids) or Azathioprine

Take Home Message:
-This study shows that for the treatment of vitiligo (vulgaris) oral mini pulsed therapy with steroids (OMP)  have the same long term results as Azathioprine (after 6 months). However Azathioprine acts more slowly.  (Study from India).
–OMP acts faster and can stop vitiligo from progressing (82.3% of treated cases 2 months after starting treatment)

Comments:
–Pulsed oral therapy against vitiligo (vulgaris) is a treatment option when topical treatments and phototherapy fail. It can be used before cellular grafting as the latter treatment is costly
–Azathioprine also has side effects and requires monitoring but it can be used as a steroid sparing agent. It would be interesting to see if it could take over OMP after the initial phase
-To read more about vitiligo, click HERE
-To read professional information about vitiligo, click HERE

Abstract
-In progressive vitiligo therapeutic modalities are limited. Betamethasone oral mini-pulse (OMP) has been used successfully, but it cannot be used in patient having co-morbidities, therefore another immunosuppressant is needed. -We compared OMP with betamethasone 5mg on two consecutive days every week vs. azathioprine 50 mg twice daily given for 6 months followed by tapering in next 4 months.
–55 patients were included (28 in OMP, 27 in azathioprine); 37 completed the study period. Acrofacial vitiligo was in 50.9% (28/55), combined acrofacial vitiligo and vitiligo vulgaris in41.8%. The age, sex, duration of disease, duration of rapid spread, type of vitiligo and BSA were comparable.
–Both OMP and azathioprine were efficacious in arresting disease activity, but in OMP at 2 months 82.3% had stoppage of progression compared to 18.2% in azathioprine (p =0.000). At 6 months most patients achieved stoppage of progression in both. Repigmentation was in 84.2% patients in OMP vs. 61.1%. At 6 months two patients of OMP group had > 20% repigmentation but none in azathioprine group achieved that much. In both groups, the colour match was excellent.
–Side effects like weight gain, acne, heartburn, hirsutism, dermatophytic infection, scabies, pyoderma, derangement of blood sugar, hypertension were noted in few patients with OMP. Urticaria, pyoderma were observed in patients taking azathioprine. One patient developed pancreatitis in azathiopine group and another peptic ulcer disease in OMP group.
-The study demonstrates the efficacy of both the drugs in vitiligo with azathioprine being inferior to OMP in rapidly arresting progression and inducing repigmentation.

Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore. RCD16-0153 Free Papers 4 (Pigment, skin cancers, others) A RANDOMIZED COMPARATIVE STUDY OF THE EFFECT OF BETAMETHASONE ORAL MINI-PULSE THERAPY VERSUS ORAL AZATHIOPRINE IN PROGRESSIVE NON-SEGMENTAL VITILIGO B. Khaitan1 1All India Institute of Medical Sciences, Department of Dermatology & Venereology, New Delhi, India