From the Research
The patient's presentation of vitiligo with delayed wound healing and striae suggests Cushing's syndrome, likely due to exogenous steroid use, and the recommended approach is to gradually taper the corticosteroids under medical supervision. The diagnosis for a patient with vitiligo, delayed wound healing, and striae is likely Cushing's syndrome, which is a condition caused by having too much of the hormone cortisol in the body. This condition can be caused by taking corticosteroid medications for a long time.
Key Considerations
- The patient's symptoms, such as delayed wound healing and striae, are consistent with the effects of excess cortisol on the body, including protein catabolism and collagen breakdown.
- The patient's vitiligo may be exacerbated by the corticosteroid use, and alternative treatments such as topical calcineurin inhibitors (tacrolimus 0.1% ointment or pimecrolimus 1% cream applied twice daily) or phototherapy may be necessary during the tapering process 1.
- A typical tapering schedule might reduce the dose by 10-20% every 1-2 weeks, depending on the current dose and duration of therapy, to minimize the risk of adrenal crisis.
- Patients should be monitored for signs of adrenal insufficiency during tapering, including fatigue, weakness, nausea, hypotension, and hypoglycemia, and supplementation with vitamin D and calcium may be necessary if the patient has been on long-term steroid therapy to prevent osteoporosis.
Treatment Options
- Topical calcineurin inhibitors, such as tacrolimus 0.1% ointment or pimecrolimus 1% cream, applied twice daily, may be used as an alternative treatment for vitiligo during the tapering process.
- Phototherapy, including narrowband UVB, may also be used to treat vitiligo, and has been shown to be effective in combination with topical calcipotriol 2.
- The recent approval of topical ruxolitinib cream brings new approaches for the management of vitiligo and paves the way for the development of new topical or oral targeted drugs 1.