Corticosteroid Minipulses
Pulse therapy refers to the administration of large (supra-pharmacologic) doses of drugs in an intermittent manner to enhance the therapeutic effect and reduce the side effects of a particular drug [9 ]. The credit of the first use of corticosteroids in p
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3.5.1
Davinder Parsad and Dipankar De
Contents 3.5.1.1
Definition and Historical Background .............. 377
3.5.1.2
Oral Corticosteroids Minipulses for Vitiligo .... 378
3.5.1.3
Personal Remarks ............................................... 378
References ........................................................................... 379
D. Parsad () Department of Dermatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India e-mail: [email protected]
3.5.1.1 Definition and Historical Background Pulse therapy refers to the administration of large (supra-pharmacologic) doses of drugs in an intermittent manner to enhance the therapeutic effect and reduce the side effects of a particular drug [9]. The credit of the first use of corticosteroids in pulse form goes to Kountz and Cohn [4], who used them to prevent renal graft rejection. Subsequently, pulse corticosteroids have been used in various dermatological as well as nondermatological indications. Oral minipulse (OMP), that is, intermittent administration of betamethasone/ dexamethasone has been pioneered in India by Pasricha et al. [6] and was first published in 1989. They first used it in vitiligo. Subsequently, OMP has been used successfully in various other dermatoses such as extensive alopecia areata [8], cicatricial alopecia, extensive/bullous lichen planus [2], trachyonychia [5], infantile periocular haemangioma [11], etc. As the indications of use of OMP suggest, it is understandable that in dermatoses for which steroid therapy is effective, OMP may be used, for maintaining efficacy and cutting down on side effects. Though controversy regarding the pathogenesis of vitiligo is far from being over, autoimmunity definitely plays a role, which has suggested to try various immunosuppressants, including topical or systemic corticosteroids. Though topical steroids are used extensively in the management of vitiligo, studies on systemic steroids have been sparingly reported in literature. The cause of this discrepancy is not known. Systemic steroids can arrest the activity of the disease, if they are used in sufficient doses for a sufficient period of time [1, 6]. They are in general not effective in repigmenting stable vitiligo. Moreover,
M. Picardo and A. Taïeb (eds.), Vitiligo, DOI 10.1007/978-3-540-69361-1_3.5.1, © Springer-Verlag Berlin Heidelberg 2010
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side effects associated with long-term use of daily systemic corticosteroids may act as deterrent against their common use.
3.5.1.2 Oral Corticosteroids Minipulses for Vitiligo In the first reported study on OMP in vitiligo by Pasricha et al. [6], betamethasone/ dexamethasone was given as a single oral dose of 5 mg on 2 consecutive days per week. This dose of steroids did not have scientific reasoning and was decided upon arbitrarily. Progression of the disease was arrested in 91% of the patients. A degree of repigmentation was observed in a proportion of patients, and the side effects were either not significant or altogether absent. In a subsequent trial of 40 patien
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