Radakovic-Fijan S, Fürnsinn-Friedl A M, Hönigsmann H, Tanew A
Divisions of Special and Environmental Dermatology and General Dermatology, Department of Dermatology, University of Vienna Medical School, Austria.
J Am Acad Dermatol. 2001 May;44(5):814-7. doi: 10.1067/mjd.2001.113475.
Oral corticosteroid pulse therapy has provided inconsistent results in the treatment of Indian patients with vitiligo.
We wanted to evaluate the efficacy, safety, and tolerability of oral dexamethasone pulse therapy in a cohort of Austrian patients with vitiligo.
Twenty-nine patients with vitiligo were included in the study. Of these, 25 had progressive and 4 had stable disease. The patients were given weekly pulses of 10 mg dexamethasone each on 2 consecutive days followed by 5 days off treatment for a maximum period of 24 weeks. Clinical response and side effects were evaluated in monthly intervals. Plasma cortisol and corticotropin levels were monitored before and up to 6 days after the dexamethasone pulse in the first and fourth week of treatment in 14 patients.
After a mean treatment period of 18.2 +/- 5.2 weeks, the disease activity was arrested in 22 of 25 patients (88%) who had active vitiligo before the study. Marked repigmentation occurred in 2 patients (6.9%) and moderate or slight repigmentation in 3 patients (10.3%) each. No response was noted in 21 patients (72.4%). Side effects were recorded in 20 patients (69%) and included weight gain, insomnia, acne, agitation, menstrual disturbance, and hypertrichosis. Plasma cortisol and corticotropin values were markedly decreased 24 hours after the second dexamethasone dose, yet returned to baseline values within the off treatment period before the next dexamethasone pulse.
Our data show that oral dexamethasone pulse treatment is effective in arresting progression of vitiligo yet fails to induce satisfactory repigmentation in the great majority of our patient cohort. Mild to moderate side effects are common with this treatment modality; however, sustained suppression of endogenous cortisol production does not occur with the pulse regimen.
口服糖皮质激素冲击疗法在治疗印度白癜风患者时效果不一。
我们想评估口服地塞米松冲击疗法对一组奥地利白癜风患者的疗效、安全性和耐受性。
29例白癜风患者纳入本研究。其中，25例病情进展期，4例病情稳定期。患者连续2天每周接受10mg地塞米松冲击治疗，随后停药5天，最长治疗24周。每月评估临床反应和副作用。在治疗的第1周和第4周，对14例患者在给予地塞米松冲击治疗前及治疗后6天内监测血浆皮质醇和促肾上腺皮质激素水平。
平均治疗18.2±5.2周后，25例研究前处于活动期白癜风患者中有22例（88%）病情活动停止。2例（6.9%）出现明显色素再生，3例（10.3%）分别出现中度或轻度色素再生。21例（72.4%）无反应。20例（69%）记录到副作用，包括体重增加、失眠、痤疮、易激惹、月经紊乱和多毛症。第二次地塞米松给药后24小时血浆皮质醇和促肾上腺皮质激素值显著降低，但在下一次地塞米松冲击治疗前的停药期内恢复到基线值。
我们的数据表明，口服地塞米松冲击治疗可有效阻止白癜风进展，但在我们的大多数患者队列中未能诱导出令人满意的色素再生。这种治疗方式常见轻度至中度副作用；然而，脉冲疗法不会导致内源性皮质醇分泌持续受抑制。
