Systemic corticosteroids in vitiligo: Evidence-based insights and practical considerations

Vitiligo is an acquired pigmentary disorder marked by the progressive destruction of melanocytes, leading to depigmented patches. Autoimmune mechanisms are recognized as the primary pathogenic driver. Systemic corticosteroids have been employed as immunomodulatory agents, particularly in cases of rapidly progressive or active disease, to halt melanocyte loss and promote repigmentation. This review provides a comprehensive, evidence-based overview of their role in vitiligo management, covering therapeutic regimens, efficacy, safety, and clinical application. A structured literature search of PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including clinical trials, meta-analyses, observational studies, and practice guidelines. Findings indicate that systemic corticosteroids – especially in pulse regimens such as dexamethasone oral mini-pulse (OMP) and betamethasone OMP – are effective in arresting disease progression and achieving partial repigmentation, with a more favorable safety profile than continuous daily therapy. Careful patient selection, appropriate dosing schedules, and regular monitoring are crucial to balancing efficacy and minimizing adverse effects. Overall, systemic corticosteroids remain a cornerstone in the management of active vitiligo, often serving as an adjunct to other therapeutic modalities for optimal outcomes.