Oral Mini-pulse Therapy Research Articles

Combination of total glucosides of paeony, narrow-band ultraviolet B, and oral corticosteroid mini-pulse therapy for nonsegmental vitiligo: A retrospective study.

The total glucoside of paeony (TGP) is recognized for its immunomodulatory properties and anti-inflammatory effects. This study evaluates the efficacy of TGP combined with oral mini-pulse therapy (OMP) and narrow-band ultraviolet B (NB-UVB) in treating active nonsegmental vitiligo (NSV). The combination therapy was contrasted against those from a group treated solely with OMP and NB-UVB. Data from 62 patients undergoing TGP combination treatment and 55 without were analyzed over a 3-month period. After 6 months, the differences in recurrence rate were investigated by follow-up. The findings indicate that integrating TGP may yield superior outcomes compared to OMP + NB-UVB alone. Moreover, the patient's oxidative stress makers were significantly reduced after the treatment. The majority of patients in the TGP cohort exhibited enhanced skin pigmentation over the duration. Notably, no increase in side effects or recurrence was observed in this group. Especially, patients with vitiligo on their head and neck experienced pronounced improvements. The efficacy of the combination treatment group was better than that of the control group at 2 and 3 months, and there was no difference in recurrence rate and side effects, suggesting that TGP may continue to show efficacy in NSV for a longer period of time by reducing the level of oxidative stress, and is especially suitable for patients with head and neck lesions.

Role of Koebner phenomenon in predicting the clinical profile and course of vitiligo

Background: Koebner phenomenon (KP) is a clinical indicator of disease activity in vitiligo. Few studies have suggested that it may also be used to predict the clinical profile, prognosis, and response to therapy. Aims: To compare the clinical characteristics of vitiligo patients with different types of KP in an Indian population. Methods: A prospective longitudinal observational study was conducted from January to November 2016. Classification of KP was done according to the Vitiligo European Task Force guidelines into KP1-by history and KP2-by clinical examination (2A: lesions on friction areas and 2B: trauma-induced lesions). Results: Of the total 160 patients, KP was observed in 102 (63.8%) cases. Type 1 KP was seen in 43 (26.9%), type 2A in 87 (54.4%), and type 2B in 34 (21.3%) cases. Patients with KP1 and KP2B had an earlier age of presentation and disease onset, while those with KP2A had a higher age of presentation and disease onset. Incidence of other autoimmune disorders, higher BSA involvement and requirement of betamethasone oral mini pulse therapy were significantly higher in cases with KP1 and KP2A, while significantly elevated anti-thyroid peroxidase levels were seen in cases with KP2A. Also, lesser treatment response was noted among cases with KP1 and KP2A. Conclusion: KP is associated with increased disease activity and more extensive involvement of vitiligo. Type 2A KP was associated with a higher incidence of other autoimmune disorders, more extensive disease, and the use of systemic steroids for treatment, which were not seen in KP2B. Thus, these groups might define two different subsets of patients.

Effect of Topical 5% 5-Fluorouracil with Microneedling in Vitiligo Patients as an Additional Modality to Standard Treatment at Tertiary Care Hospital

Abstract Background: Vitiligo is an inveterate disease of great aesthetic concern presenting with depigmented macules and patches. It is often incorrigible to medical treatment. Aim: To study the clinical profile of vitiligo patients and evaluate the effect of 5% 5-fluorouracil (5-FU) cream with microneedling. Materials and Methods: This observational analytical study was conducted from November 2019 to July 2021. A total of 33 adult vitiligo patients were treated with oral mini-pulse (dexamethasone) therapy and topical corticosteroid (clobetasol propionate 0.05%). Patient’s total number of vitiligo lesions with <10-cm size were counted and half of the lesions were treated with 5-FU + microneedling (Group A), while a remaining number of lesions were not treated with 5-FU + microneedling (Group B). In the case of the odd number of lesions, the total number of lesions minus one was considered and then divided into equal numbers for treatment. The procedure was performed every 2 weeks for 3 months. Clinical improvement was assessed monthly till 6 months by serial clinical photographs and grading scores. Results: Initiation of repigmentation started in the first month in Group A, whereas in Group B, it was seen in the second, which was statistically significant (P < 0.0001). Excellent improvement (>75% repigmentation) was noted in Group A as compared to Group B at the end of 6 months (P < 0.0001). Conclusions: Needling with 5% 5-FU appears to be a simple, safe, and effective treatment in vitiligo. It can be used in poor responders to conventional therapy.

Improvement in Lesions of Co-Existing Lichen Amyloidosis and Vitiligo with Dexamethasone Oral Mini Pulse Therapy.

Improvement in Lesions of Co-Existing Lichen Amyloidosis and Vitiligo with Dexamethasone Oral Mini Pulse Therapy.

Efficacy and safety of oral methotrexate versus oral mini pulse betamethasone therapy in the treatment of lichen planus: a comparative study

Background Lichen planus (LP) is a chronic inflammatory mucocutaneous disease. Systemic corticosteroids are the treatment of choice for generalized LP but their use is limited due to side effects. Oral mini pulse (OMP) therapy represents a good alternative. Also, Methotrexate (MTX) can be used as an alternative and safe modality in LP. Objectives To compare the efficacy and safety of oral MTX versus OMP betamethasone in the treatment of different types of LP. Patients and method The study included 40 patients presenting with LP who were randomly divided into two groups. Group A for oral MTX 7.5 mg weekly & group B for OMP betamethasone 3 mg weekly for a maximum of 12 weeks. Basic laboratory investigations were done on both groups. Follow-up investigations were done on the 2nd, 4th, 8th and 12th weeks. The percentage of improvement in each patient was calculated on a scale according to the appearance of new lesions, degree of pruritus/pain, subsidence of cutaneous lesions and clearance of the oral lesion Results In the MTX group, 55% of patients showed excellent improvement, 25% showed good improvement and 20% showed partial improvement. In the OMP group, 85% of patients showed excellent improvement, 10% showed good improvement and 5% showed partial improvement. The reported clinical and laboratory adverse effects were tolerable and didn’t lead to the discontinuation of treatment. Conclusion OMP betamethasone and low dose MTX may be considered effective and safe lines of treatment for different types of LP and may represent good and safe alternative options for conventional daily corticosteroid therapy.

Comparative study of adverse drug reactions of corticosteroids

Background: In Dermatology, corticosteroids (CSs) are widely prescribed in either topical or systemic formulations in various potencies to tailor therapy according to severity of the underlying condition, area of involvement, and patient’s age. CSs, however, are associated with a number of serious adverse effects, particularly with long-term usage. Aims: To study the relationship of adverse drug reactions (ADR) of long-term glucocorticoids (GC) with age, sex, smoking, alcoholism, underlying dermatologic conditions and co-existing medical disorders. To study CSs in relation to musculoskeletal system, metabolic & blood sugar levels and eye complications. To compare the ADR in cases on Oral mini pulse therapy (OMP) and Daily glucocorticoid (DGC) therapy groups. Methods: This was a hospital based prospective study done on 130 patients on OMP or Daily glucocorticoid therapy for more than 1 month duration, over a period of 2 years. Results: Cushingoid features and weight gain were observed in both groups. Bone changes, diabetes mellitus and hypertension were seen in patients on DGC therapy. Bone changes were seen in 17 (18.88%), Steroid induced Diabetes Mellitus (SDM) in 27(30%), Hypertension in 12(13.3%), Lipid abnormalities (in the form of raised cholesterol and triglyceride levels) in 7 (7.77%), Cataract in 12(13.33%) and glaucoma was seen in 1(1.11%) out of 90 patients on Daily glucocorticoid therapy.1 patient each out of 40 in the OMP group developed cataract and hypertension. Conclusion: In conditions like vitiligo, alopecia areata and lichen planus particularly in children, it is preferable to give OMP. In pemphigus group of disorders while using daily GC therapy, continuous monitoring and ADR prevention measures should be considered for patient's benefit.

Efficacy of narrow band UVB with or without OMP in stabilization of vitiligo activity in skin photo-types (III-V): A double-blind, randomized, placebo-controlled, prospective, multicenter study.

NB-UVB has long been the vitiligo management pillar with capability of achieving the main treatment outcomes; repigmentation and stabilization. Its stabilizing effect in dark skin has been debatable. However, randomized controlled trials regarding NB-UVB ability to control disease activity are lacking. To assess stabilizing effect of NB-UVB in comparison to systemic corticosteroids, the mainstay in vitiligo stabilization, in skin photo-types (III-V). This is a multicenter, placebo-controlled, randomized, prospective study. Eighty patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either NB-UVB and placebo (NB-placebo) or NB-UVB and dexamethasone oral mini-pulse (OMP) therapy (NB-OMP) for 6months. Sixty four patients completed the study, 34 in the NB-OMP group and 30 in the NB-placebo group. Patients were evaluated fortnightly according to presence or absence of symptoms/signs of activity. In spite of earlier control of disease activity observed in the NB-OMP group, it was comparable in both groups by the end of the study period. Disease activity prior to therapy, but not extent, was found to influence control of activity in both groups. Thus, NB-UVB is a safe sole therapeutic tool in vitiligo management. Not only does it efficiently achieve repigmentation, but also it is a comparable stabilizing tool for systemic corticosteroids in spite of slightly delayed control. NB-UVB is the only well-established vitiligo therapy that can be used solely whenever corticosteroids are contraindicated or immune-suppression is unjustified. Nonetheless, its combination with corticosteroids expedites response and improves compliance.

Oral mini-pulse steroid therapy in severe chronic urticaria

Background: Treatment of chronic urticaria can be difficult at times. The present study aimed to evaluate the efficacy of oral mini-pulse (OMP) therapy with methylprednisolone in management of severe chronic urticaria (CU). Methods and material: 100 patients with severe chronic urticaria, not controlled with maximum dose of a second generation antihistamine, were enrolled in the study after an informed written consent. All patients were treated with methylprednisolone 16 mg tablet on two consecutive days of a week for 2 months along with levocetirizine 5 mg tablet once daily. All patients were reviewed at 0, 2, 4, and 8 weeks with urticaria activity score (UAS). Results: The study comprised of 100 patients (33 males and 67 females) with severe chronic urticaria. 29 patients (29%) had raised TSH levels while Autologous Serum Skin Test was positive in 37 patients. Mean UAS in patients treated with OMP was 5.76 at baseline which reduced to 0.6 at the end of treatment period. Conclusion: Mean UAS showed a significant decline following OMP therapy with methylprednisolone. Most of the patients maintained the benefits of therapy at the end of follow up period of 4 months.

Management of Vitiligo Amidst the COVID-19 Pandemic: A Survey and Resulting Consensus.

Background:COVID-19 pandemic has changed the approach of dermatologists, with respect to management of numerous conditions, vitiligo being one of them. However, there is a lack of consensus on how to deal with patients of vitiligo, as we battle this pandemic.Aim:To conduct a questionnaire-based survey, amongst expert dermatologists; in order to understand the impact of COVID-19 on the management of vitiligo.Materials and Methods:An online semi-structured English questionnaire was prepared and the link was circulated among 50 pan-Indian expert dermatologists, through various platforms (snowball sampling). Confidentiality and anonymity were strictly maintained. Responses were analyzed at the end of the study and a consensus statement was generated.Results:42.22% of the respondents believed that teleconsultation is adequate for the diagnosis and management of most cases of vitiligo. 64.44% were found to be comfortable in prescribing oral medications, even during the COVID-19 pandemic; of which 62% would prefer to prescribe systemic steroids; followed by 17%, 11%, 7%, and 3% who would prefer cyclosporine, azathioprine, mycophenolate mofetil, and methotrexate, respectively. 64.44% respondents would recommend phototherapy in their office and 80% would prefer home-based phototherapy (PUVAsol or handheld NBUVB devices). 86.67% would prefer to stop the oral immunosuppressive drugs, till the COVID-19 RTPCR positive patients are tested negative.Limitations:The results are based on a survey of a small albeit selected group of dermatologists who decided on the currently available information on COVID-19. The same may change depending on the nature of further available information on the virus and its effect on how we manage the patients.Conclusions:Cases for initial consultation may be seen physically, and those for follow-up may be scheduled for teleconsultation. Topical therapy may be used without any hesitation. Phototherapy may be best advised with either PUVAsol or home-based phototherapy units (handheld NBUVB devices). With regards to systemic immunosuppressives, oral minipulse therapy may be preferable in view of lesser requirement of monitoring. Surgery for vitiligo should be performed only if the psychological well-being is severely affected.

Oral mini-pulse therapy in vitiligo: a systematic review.

There is limited evidence supporting the use of alternative treatments for patients with nonstable vitiligo. This study aimed to review the effects of oral mini-pulse (OMP) therapy in the management of nonsegmental vitiligo. The following databases were searched between inception and May 2020 for relevant studies: Scopus, Web of Science, MEDLINE, and Embase. All randomized controlled trials that compared OMP therapy with any other active treatment or placebo for nonstable vitiligo were included. The Cochrane's risk of bias tool was used to evaluate the risk of bias (ROB) in selected studies, and the overall quality of evidence of each outcome was assessed using the Grading Recommendations, Assessment, Development, and Evaluations (GRADE) system. Four studies met our selection criteria. All of them were conducted in India and included 246 patients. OMP therapy included betamethasone or dexamethasone. The duration of treatment was 6months in all studies. Up to 32% of patients achieved a repigmentation rate of >75% when OMP therapy was administered as monotherapy. No difference was observed between OMP therapy and other treatments in arresting the disease, and weight gain was the most frequent adverse effect. The overall ROB in all included studies was relatively high because of the randomization process, outcome measurement and informed selection of outcomes. Based on the findings of these studies, OMP therapy did not demonstrate additional value compared with other treatments. Hence, there is an urgent need to conduct high-quality clinical trials to evaluate this therapy.

A randomised, open label comparative study of hydroxychloroquine with betamethasone oral mini pulse in the management of patients with alopecia areata

Background: Alopecia areata is an autoimmune disorder causing patchy hair loss on scalp and other parts of the body and leading to poor self-esteem and anxiety in patients. Treatment with topical or systemic drugs like steroids or other immunosuppressants is associated with adverse effects. Hydroxychloroquine is an antimalarial drug, with T cell modulating function. This study was undertaken to assess the safety, efficacy and tolerability of Hydroxychloroquine in Alopecia areata compared to betamethasone oral mini pulse (OMP) therapy. Methods: 60 patients with alopecia areata were randomized into two groups of 30 each. Control group received tab. betamethasone 5 mg/day on two consecutive days of week for 12 weeks and Study group received tab. hydroxychloroquine 200 mg/day for 12 weeks. They were followed-up for further 12 weeks. Scale of alopecia tool, dermatology life quality index and global assessment at baseline, 12 weeks and 24 weeks were used to assess the outcome.Results: 94 patients were screened and 60 patients were included. All patients completed the study. At the end of 12 weeks, there was a statistically significant reduction in SALT and DLQI scores in both control and study groups. But at the end of 24 weeks, the study group showed an increase in the scores. Relapses were more in the study group. No significant difference in the incidence of adverse events was noted between the two groups.Conclusions: Hydroxychloroquine 200 mg/day is less efficacious in the management of alopecia areata in comparison to betamethasone oral mini pulse therapy.

A randomized comparative study of the effect of betamethasone oral mini-pulse therapy versus oral azathioprine in progressive nonsegmental vitiligo

To the Editor: In progressive vitiligo the available therapeutic modalities are limited. Systemic corticosteroid in the form of oral mini-pulse (OMP) therapy has been successfully used in several studies.1-3 There is always a need for another immunosuppressant, and with its effect on both T and B lymphocytes, azathioprine can be a potential alternative.4

Oral Pemphigus treated with minipulse therapy.

Pemphigus is a chronic potentially fatal autoimmune disorder that causes blisters and erosions of the skin and oral mucous membrane. Most of the cases present oral manifestations as the first clinical sign along with dermal lesions. Only 0.5 to 3.2 of cases are reported each year per 1,000,000 population with oral manifestations without dermal participation, and is at times difficult to diagnose. We report a case of oral pemphigus vulgaris in a 20 year old female patient without dermal manifestations treated with oral mini pulse therapy.

A clinical study on alopecia areata

<p class="abstract"><strong>Background:</strong> Alopecia areata (AA) is a common auto-immune condition, causing hair loss. This disease has limited treatment modalities. Through this study, comparison between established modalities of treatment such as oral mini pulse therapy, intralesional corticosteroids and platelet-rich plasma (PRP) as a newer modality has been done. The objective of the study was to evaluate the efficacy and safety of various treatment modalities in alopecia areata.</p><p class="abstract"><strong>Methods:</strong> 45 patients with alopecia areata presenting to the OPD of Dermatology, Dhiraj hospital, Pipariya were included in this study. It was conducted as a randomized prospective study for a period of 16 weeks. After taking informed consent, patients were randomly distributed into three treatment groups. Group 1 patients were treated with Tab. Betamethasone 0.1 mg/kg every Saturday and Sunday, Group 2 was treated with Inj. Triamcinolone acetonide 10 mg/ml for scalp and 2.5 mg/ml for eye brows and face was injected into deep dermis; Group 3 was treated with Dermaroller followed by application of activated platelet rich plasma (PRP). SALT score was calculated at first visit and 16 weeks. Regrowth was calculated using Mac Donald and Null Horis grading Scale at 16 weeks.<strong></strong></p><p class="abstract"><strong>Results:</strong> The SALT score reduced from 13.27 to 7.52 in Group 1, 13.93 to 8.16 in Group 2 and 42.32 to 21.12 in Group 3. Mean grade of regrowth of hairs observed was 3.47, 3.80, 2.93 in Group 1, 2, 3 respectively. The results were analysed using paired t test.</p><strong>Conclusions:</strong>Intralesional corticosteroids viz. triamcinolone acetonide still remains the first choice of therapy for AA in adults with limited involvement. Systemic corticosteroids give lower response than intralesional steroids. Platelet Rich Plasma (PRP) showed promising results, especially in children and in extensive involvement. Compared to other treatment modalities Inj. PRP is safe and with less side effects.<p> </p>

Oral Mini Pulse Therapy a Novel Therapy in a Management of Multivariant Oral Lichen Planus: An Unusual Case Report

Oral lichen planus (OLP) is a chronic mucocutaneous disease with an unknown aetiology, affecting 0.5%-2% of the population and with a predilection for females in fourth to fifth decade of life. Most oral lichen planus lesions are asymptomatic but the atrophic and erosive forms of OLP can cause symptoms ranging from spontaneous soreness to severe pain interfering with eating, speech and swallowing. Various drugs have been used for the treatment of OLP including corticosteroids and other immunomodulators. However, no therapy is considered as the single most effective and without side effects in the management of this enigmatic disease. This is a case report of successful management of extensive, symptomatic multivariant OLP with a novel treatment with oral mini pulse (OMP) therapy.

Efficacy of Betamethasone Oral Mini-Pulse Therapy in the Treatment of Lichen Planus

Lichen planus (LP) is a common inflammatory disorder that affects the skin, mucous membranes, nails and hair. There are various modalities of treatment but none is curative. Betamethasone oral mini-pulse (OMP) therapy has been used effectively and safely in vitiligo, alopecia areata and lichen planus. We sought to evaluate the efficacy and safety of Betamethasone OMP in patients with lichen planus. This prospective study was carried out among patients with lichen planus fulfilling the inclusion criteria, attending the skin and VD outpatient department of Dhaka Medical College Hospital, Dhaka Bangladesh over a period of 6 months from January 2005 to June 2005. A total of 20 patients with lichen planus diagnosed clinically and confirmed by histopathological examination were selected randomly for this study. Among them both male and female were in equal number. The study subjects were treated with 5 mg of Betamethasone orally on 2 consecutive days per week, for 3 months. Treatment response and side effects were monitored 4 weekly. The response was good in 60% and fair in 40% and there was no excellent response. This study indicates that further prospective placebo controlled studies are needed to clarify the efficacy of oral Betamethasone in lichen planus.Faridpur Med. Coll. J. Jul 2015;10(2): 47-49

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

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.

Oral Mini - Pulse Steroid Therapy in the Treatment of Dermatological Diseases : Review of the Literature

Background: Pulse therapy is a type of systemic management in which large amounts of medications are administered to patients in short time and intervals (e.g. weekly) to get the stronger effects of medication sooner and avoid long term use of them. Objective: To determine how therapy-resistant diseases respond to oral minipulse steroids . Methods: Articles with Mesh terms dermatology and were searched in PubMed database .we chose case reports and clinical randomized controlled trials on oral steroid minipulse therapies of diseases. Results: Most articles and case reports mentioned the successful treatment of refractory diseases like lichen planus, vitiligo and alopecia areata with oral mini -pulse steroids. Conclusions: Oral mini pulse has stronger beneficial effects and fewer side effects than daily systemic corticosteroids. Since it is administered twice weekly , patient compliance will be better. Therefore, oral corticosteroids minipulse can be a good alternative to daily systemic corticosteroids in dermatologic diseases. Egyptian Dermatology Online Journal Vol. 10 No 2: 1, December 2014 2 http://www.edoj.org.eg Introduction Corticosteroids have been used in since a long time ago. Pulse therapy is a type of systemic management in which large amounts of medications are administered to patients in short time and intervals (e.g. weekly) to get the stronger effects of medication sooner and avoid long term use of them [1]. Pulse steroid therapy was firstly used in a patient with renal allograft in 1969 [2]. Oral mini pulse (OMP) is a type of pulse steroid therapy which is given orally in intervals to patients[1]. It is more comfortable for patients to comply with than daily systemic steroid therapy [3]. Pasricha et al. [4] used OMP in the treatment vitiligo for the first time and later it was used in other dermatological conditions such as lichen planus, alopecia areata, nail dystrophy, infantile periocular hemangioma and etc. Our article is a short review about the clinical use of oral minipulse steroid in the treatment of different dermatological diseases to determine how therapy-resistant cases respond to oral steroid pulse therapy till now. Methods: We searched the PubMed data bank using the following MESH-terms: pulse therapy, steroid, dermatology. We limited our search for clinical trials and case reports on treating dermatologic refractory cases with only oral mini pulse steroids. We didn't have access to the most full articles so we used abstract forms of the articles. There were 7 case reports and 17 original articles found on oral minipulse therapy and diseases.

Type 2A Koebner phenomenon in vitiligo is distinct from other subtypes: observations from an Indian cohort

Koebner phenomenon (KP) in vitiligo has been redefined and classified recently. To study the clinical characteristics of various grades of KP. In this prospective cross-sectional study, 202 patients with vitiligo were studied between January 2011 and December 2012 for the presence of KP. Based on the new Vitiligo European Task Force guidelines, KP was classified as type 1-3 and grades Ι-IV. Disease characteristics were studied in the various groups and subgroups based on the presence of KP. Koebner phenomenon was seen in 130 of 202 patients. The mean age of patients showing KP was 23.9 ± 13.6 years, compared with 19.3 ± 12.4 years for patients not showing KP (P = 0.02). The mean body surface area involved in the KP-positive group was 4.6 ± 5.6%, vs. 1.5 ± 1.1% in the KP-negative group (P = 0.001). Fifty-five patients experiencing KP received low-dose dexamethasone oral minipulse therapy compared with nine of those who did not (P = 0.01). Of the 130 patients with KP, grade Ι KP was seen in 32, grade II KP in 116, grade III KP in 22 and grade IV KP in 16. There was a significant difference between type 1 and type 2A KP, and between type 2A and type 2B KP. In contrast, type 1 and type 2B KP were found not to be significantly different and had a good degree of correlation. Patients with KP have a significantly higher age at onset, more extensive cutaneous involvement and are more likely to receive systemic steroids for disease control. Type 2A disease was found to be distinct from the other subtypes.

Randomized controlled study to evaluate the effectiveness of dexamethasone oral minipulse therapy versus oral minocycline in patients with active vitiligo vulgaris

Oral minocycline has been recently shown to halt disease progression in active vitiligo. The present study was planned to compare the efficacy and tolerability of oral minocycline with oral mini pulse (OMP) corticosteroids in active vitiligo. A total of 50 patients with actively spreading vitiligo were randomized to receive either minocycline 100 mg/day (Group I-25 patients) or OMP 2.5 mg dexamethasone on 2 consecutive days in a week (Group II-25 patients) for 6 months. These were followed-up at every 2 weeks interval. Mean vitiligo disease activity score (VIDA) and mean Vitiligo Area Scoring Index (VASI) were assessed in all patients in addition to the photographic comparison before and after treatment. Both groups showed a significant decrease in VIDA from 4.0 to 1.64±0.86 (P<0.001) in Group I and from 4.0 to 1.68±0.69 (P<0.001) in Group II. However, the difference between the mean VIDA scores in the two groups was not statistically significant (P=0.60) at the end of treatment period. The mean VASI declined from 1.71±1.45 to 1.52±1.43 Group I (P=0.06) and from 1.39±1.31 to 1.17±1.34 in Group II (P=0.05). The difference between VASI in Group I and II was not significant at the end of 24 weeks of treatment (P=0.11). Both dexamethasone OMP and oral minocycline are effective drugs for managing the arrest of disease activity in vitiligo.