Systemic Corticosteroids in Vitiligo

Vitiligo is an acquired disorder characterized by depigmented macules on skin, hair, and mucosa. Its prevalence worldwide is 0.1-2% and varies from country to country.1 It is associated with high psychiatric morbidity and dysfunction, particularly in darker skin types where the contrast between normal and depigmented skin is highly pronounced.2,3 The usual approach to the treatment of vitiligo has been to regain pigment in vitiliginous areas rather than controlling the disease process. This is akin to treating the effects of the disease rather than treating the disease itself. Such an approach frequently results in frustration because patients can continue to develop new lesions at other sites even while existing lesions are repigmenting, or the disease may be reactivated at a later stage even after achieving a fair degree of therapeutic success.4 Therefore, the important priority for the treatment of vitiligo should be first to control the disease process, and then taking measures to repigment existing lesions. Systemic corticosteroids are a broad group of drugs that are widely used in various dermatological and non-dermatological conditions. Corticosteroids, both topical and systemic, have been used in vitiligo for over four decades with some concern about its efficacy as well as its known or expected adverse effects. Further research may provide evidence that systemic corticosteroids may be an important modality for the treatment of progressive vitiligo.