This protocol covers the management of vitiligo presenting as rapidly progressive disease — cases with extensive depigmentation that is actively and rapidly spreading. The overriding clinical priority in this setting is halting disease progression before further skin involvement occurs.
Rapidly progressive vitiligo with extensive and rapidly spreading involvement. Active disease spread distinguishes this presentation from stable vitiligo and calls for interventions specifically targeted at arresting ongoing progression rather than simply promoting repigmentation.
Arrest of disease activity — achieving cessation of further depigmentation spread. Stabilising the extent of disease is the primary measure of treatment success in this scenario.
Management in this setting centres on an oral steroid minipulse (OMP) approach to arrest active progression. Narrowband UVB (NB-UVB) phototherapy is the preferred first-line phototherapy modality for rapidly progressive disease and may be used in combination with OMP. The full regimen — including agent selection, schedule, duration, and safety guidance — is available in the complete protocol.
Full regimen details, decision criteria, and combination sequencing available below ↓DOI: 10.1111/jdv.19450
The experts recommend oral mini-pulses of moderate doses of betamethasone (5 mg) or dexamethasone (2.5-5 mg depending on body weight) twice weekly on 2 consecutive days per week for the treatment of rapidly progressive vitiligo to stop disease progression, after careful consideration of the risks and benefits.
OMP therapy in patients with extensive and rapidly spreading disease was reported to arrest the activity of the disease in more than 80% of patients.
NB-UVB is the preferred first-line therapy for widespread or rapidly progressive disease.
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