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To the Editor: Dr Hossain raises an important point in his letter noting the variability of assessment scales used by various authors when documenting repigmentation for people with vitiligo. He is correct that the semiquantitative scales used are not very accurate and that there is no consistency of terms. This vagueness and imprecision in use of medical terms is a common problem in clinical medicine and dermatology. Lowell Goldsmith is working on a lexicon to standardize the terminology for dermatology as part of a huge National Institutes of Health grant. And I don't need to remind you of how imprecise we are in clinical and science reports.Having said that, and having agreed with Dr Hossain about the problems, I disagree with him about his proposed scale. The assessment scales that he disparages as imprecise are global scales that indicate an overall response to therapy. His proposed scale would be useful only if each depigmented macule was assessed one by one; this impractical effort is artificially too precise.It is typical for one person with vitiligo to have some lesions not respond to therapy at all (such as those on glabrous skin), to have some spots regain a small amount of pigment, to have others acquire a great deal of repigmentation, and to have a few other spots achieve total repigmentation. Some patients lose pigmentation in some spots while others are improving a little, moderately, or significantly. Dr Hossain's scale could not be adapted to this outcome (ie, marked variability).It would be helpful if everyone used the same words and the same ranges (ie, <25%, 26%-50%, 50%-75%, and >75%), but that is not likely to happen. I think that the scales currently used give the reader a reasonable idea of how effective a therapy is. Because none of them are close to being ideal, we necessarily will have to use global scales. When vitiligo is solved and new, more effective therapies are available, then Dr Hossain's proposal will be perfect. To the Editor: Dr Hossain raises an important point in his letter noting the variability of assessment scales used by various authors when documenting repigmentation for people with vitiligo. He is correct that the semiquantitative scales used are not very accurate and that there is no consistency of terms. This vagueness and imprecision in use of medical terms is a common problem in clinical medicine and dermatology. Lowell Goldsmith is working on a lexicon to standardize the terminology for dermatology as part of a huge National Institutes of Health grant. And I don't need to remind you of how imprecise we are in clinical and science reports. Having said that, and having agreed with Dr Hossain about the problems, I disagree with him about his proposed scale. The assessment scales that he disparages as imprecise are global scales that indicate an overall response to therapy. His proposed scale would be useful only if each depigmented macule was assessed one by one; this impractical effort is artificially too precise. It is typical for one person with vitiligo to have some lesions not respond to therapy at all (such as those on glabrous skin), to have some spots regain a small amount of pigment, to have others acquire a great deal of repigmentation, and to have a few other spots achieve total repigmentation. Some patients lose pigmentation in some spots while others are improving a little, moderately, or significantly. Dr Hossain's scale could not be adapted to this outcome (ie, marked variability). It would be helpful if everyone used the same words and the same ranges (ie, <25%, 26%-50%, 50%-75%, and >75%), but that is not likely to happen. I think that the scales currently used give the reader a reasonable idea of how effective a therapy is. Because none of them are close to being ideal, we necessarily will have to use global scales. When vitiligo is solved and new, more effective therapies are available, then Dr Hossain's proposal will be perfect. Assessment scale used in vitiligoJournal of the American Academy of DermatologyVol. 52Issue 6PreviewTo the Editor: During the last 5 years, several researchers have published their papers on different treatments for vitiligo. They used varied assessment scales to categorize the outcomes of their studies (Table I). Studies show a fair agreement in grading poor and excellent responses (0%-25% and 76%-100%, respectively) and a disagreement in grading other responses (those falling in the range of 26%-50% and 51%-75%). For instance, Radakovic-Fijan et al1 labeled them as moderate and marked responses, respectively, while Grimes et al2 considered them as mild and moderate responses. Full-Text PDF