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LETTER TO EDITOR
Year : 1998  |  Volume : 64  |  Issue : 6  |  Page : 309

Unstable vitiligo responding to methotrexate




Correspondence Address:
A Sandra


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Source of Support: None, Conflict of Interest: None


PMID: 20921809

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How to cite this article:
Sandra A, Pai S, Shenoi S D. Unstable vitiligo responding to methotrexate. Indian J Dermatol Venereol Leprol 1998;64:309

How to cite this URL:
Sandra A, Pai S, Shenoi S D. Unstable vitiligo responding to methotrexate. Indian J Dermatol Venereol Leprol [serial online] 1998 [cited 2020 May 25];64:309. Available from: http://www.ijdvl.com/text.asp?1998/64/6/309/4738



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Vitiligo continues to be a disease with considerable social stigma attached to it. PUVA and topical steroids remain the mainstay of treatment.[1] In stable vitiligo autologous skin grafting has become an accepted mode of treatment.[2] However the unstable cases are relatively unresponsive and cause much concern. Pasricha et al have reported the utility of oral minipulse steroids in such cases.[3] Few of our patients with recalcitrant unstable vitiligo have responded to low dose daily cyclophosphamide (personal observation). We report a patient with unstable vitiligo who responded favourably to methotrexate.

A 54-year-old female patient with a 10-year history of rheumatoid arthritis presented with a 6 month history of rapidly progressing vitiligo lesions over trunk and limbs. She was previously treated with analgesics and chloroquin for 3 years. However the latter had to be discontinued as she developed visual defects and a possible chloroquin keratopathy. Hence she was started on a once weekly dose of 7.5 mg methotrexate. At 3 months follow up after starting methotrexate her arthritis had improved and it was noticed that she had stopped developing new depigmented lesions, The rapid spread of depigmentation had ceased and there was considerable repigmentation of the existing vitiligo lesions. Although the exact etiology of vitiligo remains unclear the association with other auto-immune diseases has given credence to the auto-immune hypothesis.[1][4] Methotrexate has been reported to be useful in other auto-immune disorders like pemphigus.[5] Hence in rapidly progressing unstable vitiligo short courses of methotrexate may help in stopping progress and bringing the disease process under control.

 
  References Top

1.Boissy ER, Nordlund JJ. Vitiligo. Cutaneous Medicine and Surgery. Arndt KA, Leboit PE, Robinson JK, Wintroub BU. Philadelphia: WB Saunders;1996;1210-1218.  Back to cited text no. 1    
2.Dutta AK, Datta PK. Pigmentary disorders IADVL Textbook and Atlas of Dermatology. Valia RG. Bombay: Bhalani Publishing house; 1994;518-531  Back to cited text no. 2    
3.Pasricha JS, Khaitan BK. Oral mini-pulse therapy with betamethasone in vitiligo patients having extensive or fast spreading disease. Int J Dermatol 1993;32:753-757.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Bor S, Feiwel M, Chanarin I. Vitiligo and its etiological relationship to organ specific auto-immune disease. Br J Dermatol 1969;91:83-88.  Back to cited text no. 4    
5.Lever WF, Goldberg HS. Treatment of pemphigus vulgaris with methotrexate. Arch Dermatol 1969:100:70-78.  Back to cited text no. 5    




 

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