A 5-week low-dose prednisolone regimen for progressive vitiligo: efficacy and safety in a single-center cohort study.

Background: Progressive vitiligo lacks standardized glucocorticoid regimens, with prolonged treatments often causing adverse effects. This study evaluated a novel 5-week low-dose prednisolone strategy (0.5 mg/kg/day, tapered weekly) to balance efficacy and safety.

Objective: To assess the efficacy and safety of this regimen in halting disease progression and inducing repigmentation in progressive vitiligo.

Methods: In this single-center retrospective cohort study (January 2017 to January 2022), 319 progressive vitiligo patients (Vitiligo Disease Activity score, VIDA score ≥ +2) received the 5-week regimen. Outcomes included treatment efficacy (cessation of progression ± repigmentation), adverse events, and patient satisfaction (visual analog scale, VAS).

Results: The efficacy rate was 88.71% (283/319), with 63.60% (180/283) achieving repigmentation (grade 1: 56.7%, grade 2: 25.6%, grade 3: 11.1%, grade 4: 6.7%). Disease severity significantly correlated with treatment response (p = 0.013). Mild-to-moderate adverse events occurred in 14.1% (45/319), including weight gain (8.2%), insomnia (3.1%), and gastrointestinal symptoms (2.8%), all resolving post-treatment. Patient satisfaction was high (mean VAS: 8.88/10; 65% scored 10/10).

Conclusion: This 5-week low-dose prednisolone regimen rapidly stabilizes progressive vitiligo across ages and subtypes, with high efficacy, minimal adverse effects, and excellent patient compliance. It offers a practical alternative to prolonged steroid protocols, particularly for early intervention.