Early Systemic Glucocorticoid Treatment Suggested for Vitiligo Patients

A team of investigators led Fuquan Lin, MD, Department of Dermatology, Third People’s Hospital of Hangzhou, Hangzhou, China, suggested that early systemic glucocorticoid treatment be performed on patients with vitiligo.

The treatment was especially recommended for patients with high VIDA scores, predisposing factors and special clinical markers.

Methods

A total of 272 progressive vitiligo patients with Vitiligo disease activity (VIDA) scores ≥ 2 points and skin lesion area < 1% of body surface area were included in the study, all of whom received no systemic glucocorticoid treatment.

Data were collected from Department of Dermatology at the Third People′s Hospital of Hangzhou from June 2018 to June 2019.

The team analyzed the area and type of skin lesions, VIDA scores, predisposing factors and special clinical markers such as trichrome vitiligo, confetti-like depigmentation, Koebner phenomenon and inflammatory vitiligo.

From there, patients were randomly divided into 3 groups: the random number table topical glucocorticoid group (62) , oral prednisone and topical glucocorticoid group (76), compound betamethasone injection and topical glucocorticoid group (134 ).

The latter 2 groups were referred to as the systemic and topical glucocorticoid group.

Patients in the topical glucocorticoid group were treated with halometasone cream or 0.05% clobetasol propionate cream once a day.

For patients treated with the oral prednisone treatment, doses were adjusted once every 7 days, and gradually reduced from 30 mg/d to 20, 15, 10 and 5 mg/d. The treatment lasted 35 days.

During the treatment with compound betamethasone injection, intramuscular injection was performed once every 20 days at a dose of 1 ml for 2 sessions.

The stable disease rate was calculated in these groups after 3 months of treatment and was defined as the proportion of patients experiencing no progression during the study among the analyzed patients.

Changes in vitiligo types were evaluated after 1 year of follow-up, and a statistical analysis was carried out by using Kruskal-Wallis H test, χ2 test and Fisher′s exact test.

Results

The team reported a significant difference in the expansion rate of skin lesion area among the 3 groups ( H = 12.468, P < 0.001) after 3 months of treatment.

Likewise, the expansion rate of skin lesion area was significantly lower in the oral prednisone and topical glucocorticoid group and the compound betamethasone injection and topical glucocorticoid group than in the topical glucocorticoid group ( P < 0.001, = 0.005, respectively, α = 0.016 7).

Among the patients with slowly progressive vitiligo, (VIDA scores = 2 or 3 points) , investigators noted that the stable disease rate was significantly higher in the systemic and topical glucocorticoid group than in the topical glucocorticoid group ( χ2 = 23.973, 11.877, respectively, both P < 0.001).

The stable disease rate also differed among the patients with different VIDA scores in the systemic and topical glucocorticoid group ( χ2 = 17.122, P < 0.001) .

Patients with predisposing factors or special clinical markers showed significantly decreased stable disease rate (47.3% [35/74], 41.2% [47/114], respectively) compared with those without predisposing factors or special clinical markers (70.6% [96/136], 87.5% [84/96]; χ2 = 11.098, 47.548, respectively, both P < 0.001) after 3 months of treatment.

After 1 year of follow-up, the proportion of patients with localized vitiligo converted into non-localized vitiligo was significantly higher in the topical glucocorticoid group (41.9%, 26/62) than in the systemic and topical glucocorticoid group (21.9%, 46/210; χ2 = 10.328, P = 0.006),

Additionally, the proportion of patients with localized vitiligo converted into non-localized vitiligo higher in the group with predisposing factors or special clinical markers than in that without predisposing factors or special clinical markers.

“Early systemic glucocorticoid treatment should be performed in the progressive vitiligo patients with high VIDA scores, predisposing factors and special clinical markers,” the team wrote.

The study, “Efficacy of systemic glucocorticoid treatment and its related factors in patients with progressive vitiligo,” was published online in the Chinese Journal of Dermatology.