A 24-year-old man has generalized non-segmental vitiligo that has progressed rapidly over the past 3 months, with multiple new patches appearing each week despite narrowband UVB sessions. His dermatologist wishes to halt the active depigmentation. Which systemic regimen is most appropriate for this purpose?

• A Oral methotrexate weekly
• B Daily low-dose oral cyclosporine
• C Oral dexamethasone mini-pulse therapy ✓
• D Intravenous immunoglobulin

Explanation

Rapidly progressive vitiligo is treated with systemic corticosteroids given as an oral mini-pulse, classically dexamethasone 2.5 mg on two consecutive days per week, to arrest disease activity while avoiding daily steroid toxicity. Daily steroids are avoided because of adverse effects. Cyclosporine, methotrexate, and IVIg have no established role in arresting vitiligo progression, and immunosuppressants such as methotrexate would be reserved for coexistent autoimmune disease rather than vitiligo itself.

Reference: Rook's Textbook of Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.