LAUSR

References 1 Chavez-Alvarez S, Herz-Ruelas M, Raygoza-Cortez AK, et al. Oral mini-pulse therapy in vitiligo: a systematic review. Int J Dermatol 2021; 60: 868–876. 2 Pasricha JS, Khaitan BK. Oral mini-pulse therapy with betamethasone in vitiligo patients having extensive or fastspreading disease. Int J Dermatol 1993; 32: 753–757. 3 Patra S, Khaitan BK, Sharma VK, Khanna NA. A randomized comparative study of the effect of betamethasone oral mini-pulse therapy versus oral azathioprine in progressive nonsegmental vitiligo. J Am Acad Dermatol 2021; 85: 728–729. 4 Singh A, Kanwar AJ, Parsad D, et al. Randomized controlled study to evaluate the effectiveness of dexamethasone oral minipulse therapy versus oral minocycline in patients with active vitiligo vulgaris. Indian J Dermatol Venereol Leprol 2014; 80: 29–35. 5 Singh H, Kumaran MS, Bains A, et al. A randomized comparative study of Oral corticosteroid Minipulse and low-dose Oral methotrexate in the treatment of unstable vitiligo. Dermatology 2015; 231: 286–290. 6 Rath N, Kar H, Sabhnani S. An open labeled, comparative clinical study on efficacy and tolerability of oral minipulse of steroid (OMP) alone, OMP with PUVA and broad/narrow band UVB phototherapy in progressive vitiligo. Indian J Dermatol Venereol Leprol 2008; 74: 357–360. 7 Khaitan BK, Sindhuja T. Autoimmunity in vitiligo: therapeutic implications and opportunities. Autoimmun Rev 2021 10:102932. doi: https://doi.org/10.1016/j.autrev.2021.102932. Epub ahead of print. PMID: 34506987. 8 Radakovic-Fijan S, F€ urnsinn-Friedl AM, H€ onigsmann H, et al. Oral dexamethasone pulse treatment for vitiligo. J Am Acad Dermatol 2001; 44: 814–817. Letter to the editor: “Oral mini-pulse therapy in vitiligo: A systematic review” Dear Editor, We are glad that our article regarding oral mini-pulse (OMP) therapy in vitiligo has sparked conversation by Patra and Khaitan and raised awareness in the lack of randomized studies. Vitiligo presents in all ethnicities, and it is important to address the psychosocial impact it has regardless of the patients ́ phototype. As physicians we need to focus on the impact this disease has on the quality of life of our patients and assess it during their dermatology visits. A systematic review even mentions that current tools to evaluate the quality of life in these patients are not as specific as these patients need. We agree that there should be a universal scale to evaluate vitiligo and the arrest of its progression. This was one of the weaknesses we saw in the studies we evaluated since there is not a unified scale that is used throughout the studies, making it difficult to compare results. This is a great opportunity for dermatologists interested in vitiligo to reach a consensus and determine which scales will be the best suited to evaluate vitiligo, especially rapidly progressive vitiligo. The study by Patra et al. mentions that azathioprine is equivalent to OMP with betamethasone when compared at 6 months. We use OMP frequently in our practice, but the purpose of this systematic review was to validate our current practices with the best available evidence, which is randomized controlled trials. Because of this, the study conducted by Radakovic-Fijan et al. was not included in our review. Another thing Patra and Khaitan mention is the temporality of the results, how we need to evaluate if the risk is worth the benefit of steroids for a long time compared to other immunosuppressants which may have less adverse events. The risk of bias we present is according to the Cochrane tool, which is a very strict and objective tool used to compare studies, and it is widely used in the international literature, which is why we chose this method. The well-being of our patients is of utmost importance and the best and most valid scientific evidence available should always be used to treat their cutaneous ailments. We hope this paper continues to help create more randomized studies with clear objectives and a unified evaluation tool system regarding improvement in our patients with vitiligo.