Dermoscopic Features of Perilesional Skin of Unstable Vitiligo: A Cross-Sectional Study

Abstract

Objectives: Dermoscopy is a very useful tool in determining stability in vitiligo. Dermoscopic features of unstable vitiligo are trichrome appearance, comet tail appearance, star burst appearance, amoeboid pattern, nebular pattern, tapioca sago pattern and perifollicular hypopigmentation. Most studies are done on determining features of vitiligo lesions; however, there is lack of studies on dermoscopy in normal appearing perilesional skin. This would give an insight into the extent of the disease process, beyond the borders of skin lesions. We conducted a study on 100 unstable lesions of vitiligo and studied dermoscopic features in its perilesional skin. The objective of this study was to observe dermoscopic features of apparently normal perilesional skin in patients of unstable vitiligo. Materials and Methods: A cross-sectional study was conducted in a tertiary care centre in New Delhi. We evaluated perilesional skin of 100 unstable vitiligo lesions over a span of 1 year. The perilesional skin has been defined as area within 5 cm of the lesion. Dermoscopy was performed using DERMLITE 4 Dermoscope at 10X magnification with inbuilt white light and polarised light. Polarised light was used to study changes in the pigmentary network and other patterns. We looked for features such as pigment network, perifollicular pigmentation, presence of leukotrichia, microkoebner phenomenon and satellite lesions in the perilesional skin. Results: The study included a total of 100 unstable lesions. Majority of patients belonged to the age group of 18−30 years. Females outnumbered males (1.8:1). All cases had progressive disease and mean duration of disease was 12.07 ± 10. 85 years. Dermoscopic features of vitiligo were observed in 56% of patients even in normal appearing perilesional skin. The most common dermoscopic finding observed was reduced pigment network which was seen in 33% of cases. Perifollicular hypopigmentation and depigmentation were observed in 23 and two sites, respectively, while leukotrichia was seen at ten sites. Eight sites showed microkoebners phenomenon. Conclusion: The perilesional apparently normal skin also shows signs of disease activity in cases of unstable vitiligo. Hence, perilesional skin should also be examined carefully with the dermoscope and topical treatment and targeted phototherapy should aim at covering the normal looking perilesional skin as well, at least within 5 cm of the borders of the skin lesions. Importantly, the perilesional skin should also be examined before surgery.