Arresting Vitiligo Progression With Betamethasone Oral Mini-Pulse vs Azathioprine

vitiligo. Spreading white patches on the dorsumof the hand of a 54 year old man with vitiligo.
The efficacy of betamethasone vs azathioprine in arresting the progression of vitiligo was examined.

Oral mini-pulse therapy with betamethasone may be effective to halt the progression of rapidly spreading vitiligo, according to research published in the Journal of the American Academy of Dermatology. Additionally, researchers found that azathioprine may also help stop progression of vitiligo, albeit less quickly than betamethasone.

Adult patients with rapidly spreading, nonsegmental vitiligo were enrolled if they had >5 new lesions within the last month or >15 new lesions in the last 3 months. Patients were also included if they had vitiligo for <1 year and a new lesion in the month prior to recruitment. Study investigators randomly assigned patients to either 5 mg betamethasone on 2 consecutive days repeated every week (n=28) or twice-daily 50 mg azathioprine for 6 months (n=27). Participants in the azathioprine group had a stepwise tapering off over 4 months after the 6-month treatment.

At the second month of treatment, a total of 19 and 4 patients in the betamethasone and azathioprine groups, respectively, experienced a halt in disease progression. A greater number of individuals who received azathioprine had arrest of progression at 4 months (n=11) and 6 months (n=14), while the number of patients in the betamethasone group who experienced a halt in progression remained stable at 4 months (n=17) and 6 months (n=17).

At 6 months, a small number of patients in the betamethasone group experienced repigmentation of 20% (n=2), 10% to 20% (n=2), and 5% to10% (n=9). Only 2 patients in the azathioprine group experienced 10% to 20% repigmentation, whereas the other patients had none or <5% repigmentation.

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Limitations of the analysis include the small number of patients in the final cohort as well as the limited follow-up period.

“We also suggest that further modification may be studied where initially starting with [oral mini-pulse] and 3 to 6 months later adding azathioprine while tapering off [oral mini-pulse] in rapidly arresting the disease progression and maintaining the stability with lesser side effects,” the researchers wrote.

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Patra S, Khaitan BK, Sharma VK, Khanna N. A randomized comparative study of the effect of betamethasone oral mini-pulse therapy versus oral azathioprine in progressive non-segmental vitiligo [published online March 16, 2019]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.03.025