Question 12. Is it possible to stop the progression of vitiligo?

Key points

  • Localized vitiligo usually stops its progression in 1-2 years after its first manifestation.
  • Generalized vitiligo is progressive in 73% of the cases.
  • Administration of oral or intravenous corticosteroids may lead to the cessation of disease progression in 85% of cases.
  • Vitiligo progression could be stopped in 4 out of 5 cases by the use of potent systemic corticosteroids, but due to possible relevant side effects, the decision must be taken by expert dermatologists after careful evaluation.

Vitiligo is progressive in 73% of cases and regressive in 1.3%. We usually explain to the patients that progression depends on how the disease spreads: localized or generalized forms have different behavior. In 89% of localized vitiligo cases, disease activity ceases after 1-2 years of rapid spreading over the affected skin area, while generalized vitiligo shows less progression only when it starts on the face (52% of the cases).

In 89% of cases we can arrest patch extension in widespread vitiligo with oral minipulse corticosteroid therapy (5 mg betamethasone on 2 consecutive days per week) . Use of corticosteroid methylprednisolone 8 mg/Kg intravenously for 3 consecutive days in patients with generalized vitiligo led to temporary cessation to the disease progression in 85% of cases and repigmentation in 71% of cases. Other steroids used intravenously showed a similar degree of limiting the disease progression.

Thus, it is true that vitiligo progression could be stopped in 4 out of 5 cases by the use of potent systemic corticosteroids. However, systemic corticosteroids might have possible relevant side effects, hence, the decision for their use in limiting vitiligo progression must be taken by expert dermatologists and after careful evaluation of the individual clinical situation.

Author: Prof. Torello Lotti, MD

UPDATE: recent developments

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