802 Treatment of Active Vitiligo with Oral Dexamethasone, NBUVB Phototherapy and Clobetasol Cream Arrests Disease Activity and Induces Repigmentation

The purpose of this study was to evaluate the efficacy and safety of oral dexamethasone pulse therapy, NB-UVB and topical corticosteroid for active vitiligo, with 1-year follow-up. All patients with active vitiligo seen in the pigmentary disorders clinic at UT Southwestern Medical Center from 2014-2015 were reviewed. Active disease was defined as new lesions or extension of existing lesions confirmed by photography, Koebner, confetti-like or trichrome lesions. Inclusion criteria were: treatment with dexamethasone 4mg PO on 2 consecutive days per week for at least 2 months, NB-UVB 3 times a week and clobetasol cream 0.05% daily on 5 consecutive days per week with at least 9 months follow up. Disease activity and body surface area (BSA) involvement was determined at three visits. Twenty-four patients met inclusion criteria and were enrolled. Mean treatment duration with dexamethasone was 3.5 months (range 2-6 months). Disease activity was arrested in 22 (92%) of the 24 patients. Mean BSA involvement with vitiligo at baseline was 16%, which decreased to 11% after treatment (p < 0.0001). A total of 29% had side effects, including insomnia, weight gain and steroid induced acne. Mean duration of follow up was 12 months (range 9-15 months), at which time mean BSA decreased from 11% to 7% (p < 0.001). At 12 months, 8 (35%) of the patients had active disease, however, 7 of these patients were noncompliant with treatment. Pulse doses of dexamethasone, NB-UVB and topical clobetasol achieved arrest of disease in 92% of patients and side effects were mild. There was a mean 31% repigmentation of vitiligo lesions. Compliance with NBUVB and clobetasol therapy after dexamethasone helps maintain repigmentation.