Systemic corticosteroids can arrest the progression of vitiligo and lead to repigmentation in a significant proportion of patients, but may also produce unacceptable side effects. To minimize the side effects, we tried a new approach using mini-pulse therapy with betamethasone.

Forty patients having extensive and/or fast-spreading vitiligo were given 5 mg betamethasone/dexamethasone as a single oral dose after breakfast on 2 consecutive days per week. The response to treatment was evaluated by photographs taken every 2-4 months and recording the side effects.

Within 1-3 months, progression of the disease was arrested in 89% of the 36 patients having active disease, while 2 patients needed an increase in the dose to 7.5 mg per day to achieve complete arrest of lesions. Within 2-4 months, 80% of the patients started having spontaneous repigmentation of the existing lesions which progressed with continued treatment. The extent of repigmentation varied in different patients and even in different lesions in the same patient. It was less than 10% in 14 (35%) patients and almost complete (> 90%) in three patients. The side effects included weight gain of 5 and 7 kg in two patients, mild headache in two patients, transitory general weakness for 2 days after the pulse in two patients, and bad taste in the mouth in three patients; 23 patients, including six children, had no side effects.

Oral mini-pulse therapy with betamethasone/dexamethasone seems to be an effective treatment modality to arrest the progression of vitiligo. It also induces spontaneous repigmentation. It deserves to be tried on a large scale to evaluate its advantages over the currently available methods of treatment.