关键词: 白癜风, 糖皮质激素类, 治疗结果, 进展期白癜风, 型别转归, 诱发因素

Abstract: 【Abstract】 Objective To investigate the efficacy of systemic glucocorticoid treatment and its related factors in progressive vitiligo patients with vitiligo disease activity （VIDA） scores ≥ 2 points. Methods A total of 272 progressive vitiligo patients with VIDA scores ≥ 2 points and skin lesion area < 1% of body surface area, who received no systemic glucocorticoid treatment, were collected from Department of Dermatology, the Third People′s Hospital of Hangzhou from June 2018 to June 2019. The area and type of skin lesions, VIDA scores, predisposing factors and special clinical markers （trichrome vitiligo, confetti-like depigmentation, Koebner phenomenon and inflammatory vitiligo） were analyzed. These patients were randomly divided into 3 groups by a random number table: topical glucocorticoid group （62 cases）, oral prednisone + topical glucocorticoid group （76 cases） and compound betamethasone injection + topical glucocorticoid group （134 cases）, and the latter two groups were also called as the systemic and topical glucocorticoid group. The patients in the topical glucocorticoid group were treated with halometasone cream or 0.05% clobetasol propionate cream once a day; during the oral prednisone treatment, the dose was adjusted once every 7 days, and gradually reduced from 30 mg/d to 20, 15, 10 and 5 mg/d, and the treatment lasted 35 days; during the treatment with compound betamethasone injection, intramuscular injection was performed once every 20 days at a dose of 1 ml for 2 sessions. The stable disease rate （defined as the proportion of patients experiencing no progression during the study among the analyzed patients） was calculated in these groups after 3 months of treatment, and changes in vitiligo types were evaluated after 1 year of follow-up. Statistical analysis was carried out by using Kruskal-Wallis H test, χ2 test and Fisher′s exact test. Results After 3-month treatment, there was a significant difference in the expansion rate of skin lesion area among the 3 groups （H = 12.468, P < 0.001）, and the expansion rate of skin lesion area was significantly lower in the oral prednisone + topical glucocorticoid group and compound betamethasone injection + topical glucocorticoid group than in the topical glucocorticoid group （P < 0.001, = 0.005, respectively, α = 0.016 7）; among the patients with slowly progressive vitiligo （VIDA scores = 2 or 3 points）, the stable disease rate was significantly higher in the systemic and topical glucocorticoid group than in the topical glucocorticoid group （χ2 = 23.973, 11.877, respectively, both P < 0.001）; the stable disease rate also significantly differed among the patients with different VIDA scores （VIDA scores = 2, 3 or 4 points） in the systemic and topical glucocorticoid group （χ2 = 17.122, P < 0.001）. After 3-month treatment, the patients with predisposing factors or special clinical markers showed significantly decreased stable disease rate （47.3% ［35/74］, 41.2% ［47/114］, respectively） compared with those without predisposing factors or special clinical markers （70.6% ［96/136］, 87.5% ［84/96］; χ2 = 11.098, 47.548, respectively, both P < 0.001）. After 1 year of follow-up, the proportion of patients with localized vitiligo converted into non-localized vitiligo was significantly higher in the topical glucocorticoid group （41.9%, 26/62） than in the systemic and topical glucocorticoid group （21.9%, 46/210; χ2 = 10.328, P = 0.006）, and higher in the group with predisposing factors or special clinical markers than in that without predisposing factors or special clinical markers respectively （both P < 0.01）. Conclusions Early systemic glucocorticoid treatment should be performed in the progressive vitiligo patients with high VIDA scores, predisposing factors and special clinical markers.

Key words: Vitiligo, Glucocorticoids, Treatment outcome, Progressive vitiligo, Type conversion, Predisposing factors