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Thread: Prednisone for Vitiligo

  1. #1
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    Jan 2022
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    Default Prednisone for Vitiligo

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    Apologies as this is not an injury question but it is still medical related.

    I noticed that the skin of my arms, lower legs and torso began to lose color. I went to a skin specialist and was diagnosed with Vitiligo. He gave me some topical steroidal creams to be applied twice a day.

    Two months later some of the color has returned, but some areas, though they look less stark on my brown skin, show little improvement.

    The specialist (this time a different, more senior man) today suggested I take Prednisone (or Prednisolone) 12mg morning and 12mg in evening for two weeks. This followed by 12mg in the morning only for two more weeks.

    He said this would arrest the spread of early stage Vitiligo and help return some skin color. Actually, the spread is more or less stopped, but repigmentation is slow.

    I've taken the first day's dosage but am concerned about the side effects after having done some reading. Among them are:

    1. High blood glucose which could potentially lead to Type II Diabetes
    2. Loss of calcium in the bones leading to osteoporosis
    3. High blood pressure
    4. Water retention, moon face, mood changes and myriad other issues

    After having read about these side effects I'm not sure I want to go through with this any more. I will have to control my diet and avoid overeating. My blood pressure will also no doubt rise more than a higher baseline during training and I am not sure if that might be a risk. Though the loss of skin pigment is somewhat unsightly, I appear to be trading my general health to make it better. It sounds like a shoddy deal!

    My age is 40. I am 80kg (176lbs). I am currently on the NLP with the squat at 300lbs (maxed at 330 and dropped due to illness and time taken off due to family issues).

    I appreciate any advice on this.

  2. #2
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    Adverse effects are a problem when they're permanent or the therapy is permanent and much less of concern when those things don't apply.

    Is this something you'd have to keep doing periodically or is this supposed to interrupt the disease more permanently? That's where the cost/benefit needs to be considered.

    Note that topical steroids have the same adverse effects and you aren't necessarily at less risk than with orals since it depends on what you're using and the coverage area and application.

  3. #3
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    Everyone tolerates medications differently. But, in the month or so you’d be on it it’s unlikely you will develop any of the significant side effects of corticosteroids. Things like osteoporosis usually take more time or much higher doses before you see them. You’d be more likely to see fluid retention in the short term. Which may or may not make your blood pressure go up a bit.

    As Stef mentioned, I think the real decision point is if this will be a one time course or if you have to periodically do this. The greater your exposure to the drug, the more likely it is you’ll experience side effects.

    For a frame of reference I’m a pharmacist and I have a chronic auto-immune disease that’s has required a lifetime of on and off high dose prednisone usage. I was diagnosed at 19 and am 52 now and have remained pretty healthy all things considered. I recently finished a 6 month course of prednisone where I was consistently over 40mg daily. I’ve avoided osteoporosis so far I think thanks to always training with barbells. Fingers crossed my next Dexa scan looks good. I typically don’t see any fluid retention and high blood pressure until I’m a month into it and over 30-40mg per day. I’ve never had issues with my blood sugar. The worst part for me is the anxiety it can cause. But again, I generally don’t see that until I’m at higher doses.

    Hope that helps in your decision making.

    —Andy

  4. #4
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    Quote Originally Posted by stef View Post
    Adverse effects are a problem when they're permanent or the therapy is permanent and much less of concern when those things don't apply.

    Is this something you'd have to keep doing periodically or is this supposed to interrupt the disease more permanently? That's where the cost/benefit needs to be considered.

    Note that topical steroids have the same adverse effects and you aren't necessarily at less risk than with orals since it depends on what you're using and the coverage area and application.
    The doctor said this was to arrest the spread of Vitiligo. But maybe he was thinking that a general mitigation of autoimmune disease was necessary. This is because I also have Lichen planopilaris, which recently saw some reemergence, and Psoriasis. Both of these are autoimmune disorders.

    Your point on the topical steroids is a good one. I had not thought of it like that. Perhaps if good head-way can be made with the Prednisone then the topical application could also end sooner. It is quite a nuisance to apply these creams in the morning and night daily.


    Quote Originally Posted by SpazTheCat View Post
    Everyone tolerates medications differently. But, in the month or so you’d be on it it’s unlikely you will develop any of the significant side effects of corticosteroids. Things like osteoporosis usually take more time or much higher doses before you see them. You’d be more likely to see fluid retention in the short term. Which may or may not make your blood pressure go up a bit.

    As Stef mentioned, I think the real decision point is if this will be a one time course or if you have to periodically do this. The greater your exposure to the drug, the more likely it is you’ll experience side effects.

    For a frame of reference I’m a pharmacist and I have a chronic auto-immune disease that’s has required a lifetime of on and off high dose prednisone usage. I was diagnosed at 19 and am 52 now and have remained pretty healthy all things considered. I recently finished a 6 month course of prednisone where I was consistently over 40mg daily. I’ve avoided osteoporosis so far I think thanks to always training with barbells. Fingers crossed my next Dexa scan looks good. I typically don’t see any fluid retention and high blood pressure until I’m a month into it and over 30-40mg per day. I’ve never had issues with my blood sugar. The worst part for me is the anxiety it can cause. But again, I generally don’t see that until I’m at higher doses.

    Hope that helps in your decision making.

    —Andy
    Thanks for your experience. I will keep an eye out for weight gain, water retention, and check my blood pressure as well (i have a home monitor).

    Have you, per chance, tried amending your diet to see if it improves your situation? I've read that gluten and dairy can cause problems, and am pondering whether to trying going gluten free to see if it makes a difference.

    @stef and Andy,

    AFAIK this course would be temporary, and could end after the month. The dosage being 24mg for the first two weeks and 12mg for two weeks after suggests to me a tapering towards the end. I read that tapering is usually done for this type of treatment.

    But since the condition is chronic, it is possible I may be restarted at some future date. It may be a lifetime thing - on and off. I don't quite know right now.

    I think I will continue the medication then and see the result in a month. Thanks for the advice.

  5. #5
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    Mar 2016
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    Quote Originally Posted by Shahmatt View Post

    Thanks for your experience. I will keep an eye out for weight gain, water retention, and check my blood pressure as well (i have a home monitor).

    Have you, per chance, tried amending your diet to see if it improves your situation? I've read that gluten and dairy can cause problems, and am pondering whether to trying going gluten free to see if it makes a difference.

    @stef and Andy,

    AFAIK this course would be temporary, and could end after the month. The dosage being 24mg for the first two weeks and 12mg for two weeks after suggests to me a tapering towards the end. I read that tapering is usually done for this type of treatment.

    But since the condition is chronic, it is possible I may be restarted at some future date. It may be a lifetime thing - on and off. I don't quite know right now.

    I think I will continue the medication then and see the result in a month. Thanks for the advice.

    I've tried a number of different dietary approaches. I was vegan (gasp!) for a year or two but lost too much weight and didn't feel any better. I've also tried eliminating various "offensive" foods from my diet such as dairy and gluten. Didn't make any difference in the number or severity of the flare ups I experienced. For me, diet only really plays a role when I'm in a flare up (I have Ulcerative Colitis). Then avoiding things like dairy and gluten to do have a small (but noticeable) impact to symptoms.

    There isn't good, reliable testing for stuff like that. About all you can do is try to eliminate things you suspect are causing you issues and keep a really good notes about the changes you made, when you made them and how you felt in the weeks after.

    And, definitely taper the methylpred. It would be an unpleasant experience to abruptly stop it after taking it for a month.

    --Andy

  6. #6
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    Sep 2010
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    Two comments: I was put on a high dose course of prednisone after a sudden hearing loss. About a week in, I was squatting, and my quad tendon ruptured (the tendon pulled out of the kneecap). It has been suggested that there may be a relationship between the two. Not much I could find in the medical literature, but there it is.

    I also have psoriasis. It flares up when I eat more grains and sugar, and settles down when I don't.

  7. #7
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    Apr 2020
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    Look into opzelura, a non-steroidal cream used to treat vitiligo.

  8. #8
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    Jul 2022
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    If you can afford it/its covered by insurance narrow Band UV at a dermatologist's office is effective for vitiligo.

  9. #9
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    Jan 2022
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    Thank you all kindly for the helpful suggestions. Here is an update on my situation.

    I got through the month of Prednisone and was not prescribed any more. The idea behind the drug was to stabilize the disease, which it seems to have now done.

    I suspect the Vitiligo was caused by an increased intolerance to milk which I was drinking a lot of while training last year. I didn't know I had an intolerance, but in January I decided to go without for a few weeks and try resuming to see what happens. \

    On resumption I felt my body itch all over, and I think I saw a sudden increase in Vitiligo (but I can't be sure). In order to confirm a relationship I stopped drinking milk once again, and slowly weaned myself off any foods that had any milk in it, which are many (It's amazing how pervasive milk is in processed foods like biscuits or cookies).

    The topical creams seem to be doing a good job and the lesions look significantly improved. I have also now begun applying black seed oil to help it along. I understand that this also conveys some benefits.

    The doctors are no help when it comes to causes. It's all about addressing symptoms. So I've been trying to figure out why I have myriad immune system related disorders (vitiligo, lichen planus polaris, and psoriasis).

    Doing some reading I found several articles linking Vitamin D to immune system regulation. One paper suggested low Vitamin D was linked to lichen planus polaris.

    Another article suggested that vitiligo patients recovered skin pigmentation faster when given Vitamin B12, Folic acid and sun exposure (Vit D can be created when the skin processes UV light from the sun).

    Another piece of anecdotal evidence: My father was diagnosed with Osteopenia (early stage Osteoporosis) and was prescribed Vitamin D and Calcium, apparently Calcium absorption necessitates Vitamin D. Calcium is also found in milk.

    I can't quite put all of this information together in any logical fashion but it prompted me to get my Vitamin D levels checked (and thyroid function at the same time for good measure). My thyroid is fine, but Vitamin D is 18ug/L (micrograms per litre), so on the very low end. Apparently a healthy level is at least 40.

    So I've begun supplementing my diet with 2000IUs of Vitamin D with an additional 400IUs from multi-vitamins, and also rolling up my sleeves during the hot afternoon sun when the UV is strongest. In this hot tropical climate this looks a bit ridiculous, but it's just for about 10 mins, and if it helps cure me then it would be worthwhile. Cancer is something to watch out for, but 10 mins is not too long I hope. I've been doing this for 3 weeks so far and no melanoma yet.

    I wonder if an intolerance to milk could also be caused by low Vitamin D. I guess time will tell.

    Comments and suggestions appreciated.

  10. #10
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    Feb 2019
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    I'm a dermatologist and see patients with Vitiligo frequently. I want to say I treat them, but I have not found a really good treatment, so I work out how bothered they are and try to use the safest treatments possible and see how it goes. Topical steroids are helpful, but obviously limited by their cutaneous adverse effects. UVB to me seems fairly poor- I have never had anyone respond particularly well. Probably the most effective treatment are the calcineurin inhibitors - topical tacrolimus and pimecrolimus of which 0.1% tacrolimus (Protopic in UK) is most likely to help. It can be used much longer term without the side effects of steroids and can be used safely on the face (not necessary in your case). If a patient said they preferred not to treat I would say that was perfectly reasonable.

    As for the cause- we don't know. There seems to be a tsunami of interrelated autoimmune disease in the developed world. It will be a combination of genetics/triggers but no one is really clear in the case of vitiligo.

    Good luck

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