A Randomized Comparative Study of Oral Corticosteroid Minipulse and Low-Dose Oral Methotrexate in the Treatment of Unstable Vitiligo

Abstract

Background: Despite continued progress towards elucidation of the biochemical, genetic and immunopathological pathways in vitiligo, a definitive cure remains elusive. The initial therapy must be directed to arrest disease progression. Oral minipulse therapy (OMP) with betamethasone/dexamethasone has been tried and shown to be an effective modality to arrest the disease progression in vitiligo. Objectives: Methotrexate (MTX) is a time-tested effective treatment extensively used in various autoimmune disorders with good efficacy, safety and tolerability on a long-term basis. We intended to compare the efficacy of MTX with that of OMP in patients with unstable vitiligo vulgaris. Patients and Methods: In a prospective randomized open label study, 52 patients with vitiligo were divided into two groups. Patients in group 1 received 10 mg methotrexate weekly. Group 2 patients received corticosteroid OMP which comprised tablets of dexamethasone 2.5 mg (5 tablets), taken on 2 consecutive days in a week (total weekly dose of 5 mg dexamethasone). Results: In the MTX group, among 25 patients analyzed, during the course of treatment for 24 weeks, overall 6 patients developed new vitiliginous lesions. In the OMP group, 7/25 patients developed new lesions. Statistical correlation between the two groups showed no significance in the number of patients who developed new lesions (increasing disease activity) in either of the groups. At the end of the study, it was demonstrated that patients in both groups had a similar reduction in the vitiligo disease activity score. Conclusion: Our study demonstrated that both drugs are equally effective in controlling the disease activity of vitiligo. MTX can be used in patients with active vitiligo, wherever corticosteroids are contraindicated.

Addition of oral minipulse dexamethasone to narrowband ultraviolet B phototherapy and topical steroids helps arrest disease activity in patients with vitiligo

“…Rapidly progressive disease has been shown to respond to systemic corticosteroids; however, this treatment is associated with a high incidence of side‐effects when given continuously . For this reason, minipulse dosing of systemic steroids has been used to treat vitiligo and has fewer side‐effects . Few controlled studies have been performed using this treatment.…”

Three Women with Non-Segmental Vitiligo in Three Generations of a Family: A Case Report

“…Methotrexate has been widely used as a safe and longacting drug for treatment of different autoimmune disorders, such as psoriasis, psoriatic arthritis, alopecia areata, systemic lupus erythematosus and rheumatoid arthritis (17). According to Sing et al, oral mini pulse treatment and methotrexate have similar efficacy in controlling the activity of vitiligo (18).…”

Topical methotrexate 1% gel for treatment of vitiligo: A case report and review of the literature

“…MTX as an antimetabolite and antifolate drug is a time-tested effective treatment extensively used in various autoimmune disorders like psoriasis, psoriatic arthritis, alopecia areata, lupus erythematosus, and rheumatoid arthritis in low to moderate doses with good efficacy, safety, and tolerability on a long-term basis (Sung et al, 2000). (Singh, Kumaran, Bains, & Parsad, 2015). MXT is, hence, comparable to OMP corticosteroid in controlling disease progression.…”