How do you manage patients with rapidly progressing vitiligo?

Literature review suggests one should suspect rapid progression when the patient is developing new spots every month. This is especially distressing in patients of ethnic backgrounds.

One suggestion is pulsed steroids (either dexamethasone or betamethasone) (Pasricha and Khaitan, PMID 8225724, Radakovic-Fijan et al., PMID 11312430), in addition to NBUVB for at least 6 months (Tovar-Garza et al., PMID 30188576). The addition of topicals and other steroid-sparing agents such as azathioprine or mycophenolate mofetil (during days when off steroids) has also been studied with varying results.

While topical ruxolitin...