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Safe dosage of Betnesol in treating Vitiligo

Hi Doctor, Thanks a zillion for the response. You are right....I mistakenly mentioned 10mg as the strength of Betnesol that I have been prescribed.....its 1mg. My body weight is 56kgs, so how many tablets do I need to take on those two days of the week?? But fresh patches are appearing on the remaining 5 days when I'm off betnesol. 2. Could you please specify the dosage ( no. of tablets ) as per my body weight and the duration...how many months it can be continued safely without any side effects. 3. My age is 47yrs..Female. My vitiligo got triggered due to using an epilator on my legs for hair removal. It was a very painful process. But now one minute patch is there on my nose, around the mid septum of my nostril and one just below the edge of my left lower lip. One tiny patch has also appeared on my scalp...just above the fore head. 4.Any injury or cut resulted in a white patch initially...but now patches appear even without a trigger. I'm really concerned and worried as I've to get my daughter and son married soon. 5.I'm also taking melanocyl tablets daily and applying Whit Care and exposing to sunlight, but this has resulted in me getting fully tanned and the patches which were barely visible earlier, have now turned pink and very very prominent. Whit Care has caused re pigmentation on my legs, but neck,thighs,folds of finger, areas below the nail and most importantly neck and back have remained unaffected. 6.Additionally I'm also applying Execare cream at night....but it doesn't seem to have any result. 7.Betnesol also hasn't yet worked on my face,scalp, neck and abdomen and thighs. Only fingers are showing repigmentation. 8.Can I take Betnesol 1mg daily for 2weeks atleast, so as to stop the active phase. 9.Please advise on long term management as I'm extremely disturbed and depressed on account of this problem. Thanks Best regards
Asked On : Sat, 29 Jan 2011
Answers:  5 Views:  2305
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Dermatologist 's  Response
Hi !,
Welcome to healthcareMagic forum,
Betnesol is s good medicine for vitiligo if it is spreading or is active.The dose is approx 1 mg/kg body wt and the tablet strength is 1 mg and not 10 mg as you have mentioned.This medicine is given twice wkly dose only...as daily dose may have side effects and it has a long term result too.So kindly follow your doctors advice .Other things which you are using is fine.You can add to this treatment by using melanocyl tablets three times a wk for repigmentation,but this again needs doctors supervision and advice.
take care,
Dr.chawda
Answered: Sat, 29 Jan 2011
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  User's Response
Dear Dr. Chawda,
Thanks a zillion for the response. You are right....I mistakenly mentioned 10mg as the strength of Betnesol that I have been prescribed.....its 1mg. My body weight is 56kgs, so how many tablets do I need to take on those two days of the week?? But fresh patches are appearing on the remaining 5 days when I'm off betnesol.
2. Could you please specify the dosage ( no. of tablets ) as per my body weight and the duration...how many months it can be continued safely without any side effects.
3. My age is 47yrs..Female. My vitiligo got triggered due to using an epilator on my legs for hair removal. It was a very painful process. But now one minute patch is there on my nose, around the mid septum of my nostril and one just below the edge of my left lower lip. One tiny patch has also appeared on my scalp...just above the fore head.
4.Any injury or cut resulted in a white patch initially...but now patches appear even without a trigger. I'm really concerned and worried as I've to get my daughter and son married soon.
5.I'm also taking melanocyl tablets daily and applying Whit Care and exposing to sunlight, but this has resulted in me getting fully tanned and the patches which were barely visible earlier, have now turned pink and very very prominent. Whit Care has caused re pigmentation on my legs, but neck,thighs,folds of finger, areas below the nail and most importantly neck and back have remained unaffected.
6.Additionally I'm also applying Execare cream at night....but it doesn't seem to have any result.
7.Betnesol also hasn't yet worked on my face,scalp, neck and abdomen and thighs. Only fingers are showing repigmentation.
8.Can I take Betnesol 1mg daily for 2weeks atleast, so as to stop the active phase.
9.Please advise on long term management as I'm extremely disturbed and depressed on account of this problem.
Thanks
Best regards
Answered: Thu, 3 Feb 2011
Dermatologist Dr. Bharat Chawda's  Response
Hi !,
Welcome to healthcareMagic forum,
sorry for the delay in replying as i had gone for a conference.Betnesol is a steroid which helps to stop the growth of new patches ,and it needs proper investigations and proper follow up if you want to take this for a long time..esp like your blood sugar level and blood pressure has to be maintained.I wouldn't advice you to take treatment online ,but i can guide you whatever you want to know.According to body wt betnesol is given 1 mg per kg body wt....i.e. in your case it would come approx 3 tab on two consecutive days(6tab a wk).This is taken early morning after breakfast .Along with this you should also take tab ranitidine twice a day to prevent gastritis.For all this you should meet a dermatologist nearby.Kindly tell me where you belong to so that i can guide you a good dermatologist at your place.Tab melanocyl as you have mentioned you are taking daily is not the wright method.It should be taken alternate days (dose is 0.6mg per kg body wt) followed by sunlight exposure after 2hrs.While doing this You should also use sunglasses esp when you are out in sun to protect your eyes .As you said you have marriageable age children,then if you want you can go for some temporary camouflage systems which can temporarily hide your patches.Creams which you are using are fine and can be continued .For face you can use tacrolimus cream aswell.Since your vitiligo is an active vitiligo therefore whenever there is a trauma it can lead a white patch.Also rule out thyroid disorder in your case.as it is associated with vitiligo.
take care,
Dr.chawda
Answered: Mon, 7 Feb 2011
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  User's Response
Hi Dr. Chawda,
Thank you once again from the core of my heart for the guidance.I'm at present residing in Srikakulam .. a town near Visakhapatnam. I'm consulting a doctor in Visakhapatnam . I also read in many forums that consuming melanocyl daily and exposing to sunlight for 30min after applying Whit-Care can be dangerous. But I have been doing this for the past 2months. I was very very fair , but now my skin is tamarind color and I might turn into a negro soon!! My doc. insists its OK and people tend to over state on the net. I started off with Momate cream, then it was changed to Flucort and now its Execare ( Dr. Reddy'd Lab ). Only thing is that I have now been put on Betnesol 1mg as I needed an immuno suppressant. My doc wants me to stop Betnesol after 2weeks... (ie after 3 days ). But I'm anxious as fresh patches may appear once I stop. My healing is excellent while I am on Betnesol. My doc wants me to stop Betnesol and observe.

1. Do you think the duration of steroid treatment is enough to suppress my immune system???? Or I can continue it on a lower dose for few more weeks? My body weight is 56kgs. Height 5' ( 155cms ).

2. I'm not diabetic, bit hypothyroid and taking 100mcg of Eltroxin daily morning in empty stomach. BP is also normal with medicines. I got all blood tests done before commencement of treatment..and everything was normal. BP - I monitor on a regular basis. Its normal uptill now..inspite of me being on steroids for the past 2 weeks. But I read online that Betnesol can also lead to cardiac arrest and glaucoma..resulting in blindness. I do get hot flushes at times though ..but not regularly.

3. Melanocyl with Whit-Care and exposure to sunlight can be continued for how many months. The treatment is very effective for the legs / fingers. Neck and back...minor results are showing up now..

4. Is it safe to apply Whitcare everyday and expose to sunlight for 30min... if I don't take melanocyl. ( In South India..sun rays are very sharp unlike Northern part of India ). I moved to Vizag about 6weeks back from Kolkata. In Kolkata the winter sun was unable to tan my complexion. But in Vizag, I've gone pitch dark, while my chest and abdomen are still pinkish white !!!

Do you think exposure time should be lowered considering the sun's heat in this part of the country.

5. I'm not exposing my face to sunlight, so do I still need to wear sun glasses? The tiny patch on my nose and around the nostrils are healing on their own and barely visible now. But if I expose my face to sun light, the discolored patch becomes prominent due to contrast.

6. Scalp also seems to be healing..only a moong dal sized patch was there on the front parting.

Looking forward to your further guidance and advise, since I'm really confused and depressed on account of this horrible development in my life. Do rush back panacea.

Best Regards
Answered: Mon, 7 Feb 2011
Dermatologist Dr. Bharat Chawda's  Response
Hi !,
Welcome to healthcareMagic forum,
Strictly speaking melanocyl should be taken every alternate days,but if your doctor is keeping a track of the side effects then its ok.The only thing of concern while taking melanocyl is liver toxicity (only on long run), otherwise its a safe medicine.Tab betnesol can be given for long may be an year too if needed.side effects here too has to be followed properly like control of blood sugar and blood pressure.Glucoma and cardiac arrest are very rare.I've used betnesol on even young girls for a year or more with no side effects.There are other medicines too like azathioprine (if betnesol doesnt work) which can be given if needed in place of betnesol( azathioprin side effects has to be watched for before giving it )..Whitecare is fine and you can use it as you are using it along with sunlight.As far as tanning is concerned with melaonocyl,you should use a good sunblocking agent before exposing to sunlight.For that matter I have phototherapy chambers in my hospital where in patient can come and take light only where it is required and need not expose other parts of the body.It is very important to wear UVA protective sun glasses(atleast till evening) when ever you expose to sunlight whether you are exposing face or not.In vizag if sun is is at its peak,then you can lower the exposure time.But 30 min exposure is a pretty long time ,you should reduce it to say 15min.One thing you have you have to understand is that light exposure is a kind of medicine whose overdose should not be there,that means over exposure is not good . And as i told you thyroid ds can be associated with vitiligo,you should continue your eltroxin regularly as advised by your doc.Flucort and execare are good med and you can continue.For face you can use tarolimus cream which is more safe and better than other creams.I hope these tips are useful to you to understand your treatment and follow up.
take care,
Dr.Chawda
Answered: Wed, 9 Feb 2011
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