Vitiligo Extent Research Articles

Silymarin in combination with hair follicle transplantation as a potential treatment for refractory vitiligo: A double-blind randomized controlled trial.

There is still no certain effective treatment for vitiligo as a common chronic skin disorder characterized by depigmented patches and loss of skin melanocytes. This study evaluates the efficacy of oral silymarin combined with hair follicle transplantation compared to follicle transplantation alone in the treatment of refractory vitiligo. Twenty refractory vitiligo patients were enrolled in this randomized controlled clinical trial, following up for 3 months. One group underwent hair transplantation plus oral silymarin, while the other group underwent follicle transplantation alone. We assessed the progress with Vitiligo Extent Tensity Index (VETI) in both groups and the peri-follicular pigmentation diameter was estimated monthly. The Friedman test for comparing two groups at the end and the Mann-Whitney test for comparing two groups during each month was used. The mean age was 30.22 (18-59) years, with the male to female ratio of 1:1. The decrease in the VETI and increase in the perifollicular pigmentation was statistically significant between silymarin and another group in monthly follow-up (p-value: 0.019, 0.019, and 0.035, respectively). Finally, the re-pigmentation was notable in silymarin group (p-value <0.001 vs. 0.029, respectively). In addition, both genders had a significant increase in peri-follicular re-pigmentation in the last follow-up (p-value: 0.012 and 0.044, respectively); although the improvement was not statistically significant between genders in each month. According to our study, silymarin in combination with hair transplantation could be a potential medical treatment for vitiligo; however, further trials are needed to establish the efficacy of combination therapies.

Assessing the Relationship Between Vitiligo and Major Depressive Disorder Severity: Cross-Sectional Study.

Vitiligo, a common dermatological disorder in Saudi Arabia, is associated with significant psychological impacts. This study explores the relationship between vitiligo and the severity of major depressive disorder (MDD), highlighting the broader implications on mental health among affected individuals. We aim to assess the prevalence and predictors of depression among adult patients with vitiligo, and to examine the relationship between MDD severity and vitiligo. Using a cross-sectional design, the research used the vitiligo area severity index and the Patient Health Questionnaire-9 to measure the extent of vitiligo and depression severity, respectively. This study involved 340 diagnosed patients with vitiligo from various health care settings. Logistic and ordinal regression analysis were applied to evaluate the impact of sociodemographic variables and vitiligo types on MDD severity. The prevalence of MDD was 58.8% (200/340) of participants. Depression severity varied notably: 18.2% (62/340) of patients experienced mild depression, 17.9% (61/340) moderate, 11.8% (40/340) moderately severe, and 10.9% (37/340) severe depression. Female patients had higher odds of severe depression than male patients (adjusted odds ratio [aOR] 3.14, 95% CI 1.93-5.1; P<.001). Age was inversely related to depression severity, with patients aged older than 60 years showing significantly lower odds (aOR 0.1, 95% CI 0.03-0.39; P<.001). Lower income was associated with higher depression severity (aOR 10.2, 95% CI 3.25-31.8; P<.001). Vitiligo types also influenced depression severity; vulgaris (aOR 5.3, 95% CI 2.6-10.9; P<.001) and acrofacial vitiligo (aOR 2.8, 95% CI 1.5-5.1; P<.001) were significantly associated with higher depression levels compared to focal vitiligo. The findings suggest that vitiligo contributes to an increased risk of severe depression, highlighting the need for integrated dermatological and psychological treatment approaches to address both the physical and mental health aspects of the disease.

Clinical and pathogenetic assessment of cyclosporine efficacy in the complex therapy of non-segmental vitiligo patients

BACKGROUND: Vitiligo is a chronic disease of unknown etiology, characterized by the appearance of depigmented spots on various areas of the skin, rarely on mucous membranes, and discolored hair due to destruction and reduction of melanocytes. While not life-threatening, vitiligo significantly impacts the psychoemotional aspect. Studies assessing the quality of life of vitiligo patients reveal the presence of depression in these individuals. In addition to depression, a high susceptibility to anxiety, stigmatization, sleep disturbances, adaptation, and problems in personal relationships have been identified. The prevalence of depression and anxiety among vitiligo patients is comparable to other dermatological conditions such as atopic dermatitis, acne, psoriasis, and urticaria. This underscores the need to seek new means and methods for treating this condition. AIM: Clinical assessment of the effectiveness of using cyclosporine in combination with UVB 311 nm and monotherapy with UVB 311 nm for vitiligo. MATERIALS AND METHODS: The study involved 40 patients with progressive vitiligo. All patients were randomly divided into two groups. Group 1 (20 individuals) underwent a course of cyclosporine therapy in combination with UVB therapy, while Group 2 (20 individuals) received monotherapy with UVB 311 nm. The duration of the treatment was 6 months. The extent of the affected area relative to the body surface area was evaluated using the VES index (Vitiligo extent score) on a vitiligo calculator. The impact of the disease on the quality of life was assessed using the VitiQoL scale (vitiligo-specific quality-of-life instrument). RESULTS: All patients included in the study completed the full course of treatment. Group 1 (20 individuals) underwent a course of cyclosporine therapy in combination with UVB therapy, while Group 2 (20 individuals) received monotherapy with UVB 311 nm. Patients in the combined therapy group experienced earlier stabilization of the skin process compared to those receiving monotherapy with UVB 311 nm. Additionally, Group 1 demonstrated more pronounced repigmentation of vitiligo lesions and significant improvement in quality of life compared to Group 2. CONCLUSION: Cyclosporine in combination with narrowband phototherapy at 311 nm demonstrated good clinical efficacy and significant improvement in quality of life for non-segmental vitiligo patients. Cyclosporine is well-tolerated, has a low spectrum of side effects, and can be used long-term for patients with active vitiligo.

Exploring the Severity Strata of Disease Activity and Repigmentation in Vitiligo Based on Validated Physician Global Assessment (PGA) Scores.

Background/Objectives: There is currently no guidance on how to interpret the global degrees of activity (worsening) and repigmentation (improvement) in vitiligo. Stratification into global degrees can be completed for static evaluations (e.g., visible disease activity signs) and dynamic assessments (e.g., evolution over time). For the latter, the Vitiligo Disease Activity Score (VDAS15&60) and Vitiligo Disease Improvement Score (VDIS15&60) were recently validated. Methods: In the current study, a Physician Global Assessment (PGA) for disease activity (worsening) and repigmentation (improvement) was evaluated for validity (construct) and reliability (inter- and intrarater) based on a photo set of 66 patients. Subsequently, the PGA activity (worsening) and repigmentation (improvement) were used to stratify the Vitiligo Extent Score plus (VESplus), VDAS15&60 or VDIS15&60 into three global categories (slightly, moderately and much worse/improved), based on ROC analysis. Results: For the VESplus, cut-off values for the categories 'slightly, moderately and much worse' were >0.3%, >27.71% and >128.75% BSA (relative changes in the affected total BSA), respectively. For the categories 'slightly, moderately and much improved', they were >0%, >4.87% and >36.88% BSA (relative changes in the affected total BSA), respectively. The optimal cut-off values of the number of active (VDAS15) body areas were >0 areas for slightly worse, >2 areas for moderately worse and >7 for much worse. For VDIS15, the cut-off values for slightly improved and moderately improved were >0 and >1. For VDAS60 and VDIS60, the cut-off points were >0.5, >3, >9.5 and >0.5 and >1.5, respectively. The results should be interpreted with caution in patients with extensive vitiligo due to the rather limited disease extent of the included patient population (VESplus (median: 3.2%)). Conclusions: This research will aid in the development of more detailed international definitions.

The effect of narrowband ultraviolet B on tissue level of interleukin-15 and interleukin-15 receptor alpha subunit in active nonsegmental vitiligo cases: an interventional cohort study

Background Vitiligo is an acquired depigmenting skin disorder in which CD8 effector and memory T-cells contribute to its pathogenesis and recurrence. Interleukin (IL)-15 contributes to CD8 effector T-cell cytotoxicity and CD8 memory T-cell survival and maturation. Objective To evaluate the effect of total narrowband ultraviolet B (NB-UVB) on tissue levels of IL-15 and IL-15 receptor alpha (IL-15Ra) in active nonsegmental vitiligo. Patients and methods The patients were assessed clinically for vitiligo extent and activity before and after treatment. Perilesional skin biopsies were taken from 30 vitiligo patients before and after 48 sessions of NB-UVB and from 30 healthy controls. Tissue levels of IL-15 and IL-15 Ra were evaluated by enzyme-linked immunosorbent assay before and after treatment to evaluate the effect of NB-UVB on them. Results Before NB-UVB treatment, the tissue levels of both IL-15 and IL-15Ra were significantly higher in vitiligo patients than controls; moreover, they were significantly higher than those after NB-UVB treatment. In contrast, after NB-UVB treatment, no statistically significant difference was detected between the patients and controls. The levels of IL-15 and IL-15Ra were significantly correlated, whereas they were not correlated with either vitiligo activity or extent. Conclusion IL-15 and IL-15Ra were higher in vitiligo patients than controls before treatment. However, their tissue levels were normalized after treatment with NB-UVB, emphasizing its therapeutic potential.

Ayurveda management of Shvitra (~vitiligo): A case report

Vitiligo is a pathological condition when melanocytes are destroyed, and causes patches of the skin to lose color. Vitiligo affects around 0.5%–2% of the global population. India is considered to have the highest prevalence in the world at about 8.8%. A 51-year-old male patient comes to the outpatient section with multiple white patches with a reddish tinge over the trunk, neck, elbow, and ankle. The Vitiligo Extent Tensity Index (VETI) was 17 before initiating the treatment. Considering the symptomatology, the condition is diagnosed as Shvitra (~vitiligo) with the predominance of Pitta (~regulatory functional factors of the body) and Kapha dosha (~responsible for regulating body fluids and keeping the body constituents cohesive). The case is managed with Virechana (~therapeutic purgation), Vamana (~therapeutic emesis) procedures, and Samshamana aushadha (~pacifying treatment). The VETI score reduced to 7.4 after the treatment. Although this case study provided encouraging results, there is a need for more case reports/planned clinical studies that will help in generating evidence against adopting Ayurveda treatment approaches in the management of Shvitra.

An Evaluation of the Hematological Markers of Systemic Inflammation and Oxidative Stress in Vitiligo: A Case-Control Study.

Introduction Melanocyte dysfunction in vitiligo is considered to be due to genetics, inflammation, and autoimmunity. Research has shown that oxidative stress plays a significant role in triggering these conditions. Currently, there are several markers indicating hematological inflammation and oxidative stress. This study aimed to investigate the status of inflammation and oxidative stress markers in vitiligo. Methods This study included patients with vitiligo and age-gender-matched healthy controls.C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-high-density lipoprotein ratio (MHR) and extent of vitiligo were calculated and compared. Results The study included 138 participants (69 vitiligo and 69 controls). The mean was 41.46 years with a female predominance (55.1%). The patient group demonstrated higher levels of platelets, neutrophils, CRP, NLR, MLR, PLR, and HDL and lower levels of lymphocytes and HDL compared to the control group (p>0,05).The only significantly different value between the groups was MHR (p=0.03). The generalized vitiligo group demonstrated higher levels of platelets, neutrophils, monocytes, CRP, NLR, PLR, and MLR, and lower levels of lymphocytes and HDL compared to the localized group. The only significantly different values between the groups were MHR and MLR (p=0.02, p=0.03). Conclusion This study found that MHR and CRP values were higher in vitiligo patients. Additionally, MHR and MLR values were higher in patients with generalized vitiligo. These results suggest that MHR is a reliable indicator marker for systemic inflammation and oxidative stress in vitiligo.

Stigma in vitiligo: associated factors and severity strata of the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) score.

Vitiligo is the most common cause of skin depigmentation worldwide. Patients with vitiligo may experience stigma and this needs to be addressed. To evaluate stigma in patients with vitiligo, search for associated factors and establish severity strata for the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) for patients with vitiligo. We conducted a cross-sectional study in ComPaRe Vitiligo, an e-cohort of adult patients with vitiligo. Stigmatization was assessed using the PUSH-D, a recently validated dermatology-specific stigmatization assessment tool. We conducted univariate and multivariable linear regression to identify patient and disease factors associated with the stigmatization. We used an anchor-based approach to define severity strata for the PUSH-D. In total, 318 patients participated (mean age 49.7 years; 73.9% women). Fitzpatrick skin phototype IV-VI, severe facial involvement (high Self-Assessment Vitiligo Extent Score of the face) and depression (high Patient Health Questionnaire-9 score) were positively -associated with a higher stigmatization score, although this association was weak [r = 0.24 (P < 0.001) and r = 0.30 (P < 0.001), respectively]. PUSH-D cutoff values that best discriminated patients with high and low stigma, as defined by the anchor question, were 13 and 23 (κ = 0.622, 95% confidence interval 0.53-0.71). Our study is the first to use a skin-specific stigmatization tool to assess stigma in patients with vitiligo. Creating strata helps to better interpret the PUSH-D in daily practice and may facilitate its use in clinical trials.

Quality of life, depression, anxiety, stress symptoms, and its association with vitiligo extent and distribution: A cross-sectional study

Objectives: Vitiligo, a globally prevalent psychocutaneous disorder (incidence: 0.1–2%), profoundly affects mental health. It often leads to depression and anxiety, particularly when more body surface area (BSA) is involved. Lesions appear on both exposed and unexposed skin, significantly impairing patients’ quality of life (QOL). The objectives of the study are to assess depression, anxiety, stress, QOL, and their relationship with BSA in vitiligo patients. Materials and Methods: We conducted a cross-sectional study with 50 vitiligo patients, gathering sociodemographic data using a self-designed form. BSA affected was calculated using the “rule of nines.” Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scale 42. QOL was assessed using the Dermatology Life Quality Index and the World Health Organization QOL questionnaire BREF. Data analysis utilized SPSS version 20.0, adhering to ethical guidelines. Results: Depression, anxiety, and stress rates were 36%, 38%, and 32%, respectively. Depression prevalence was 21.7% in patients with &lt;10% BSA affected and 100% in those with &gt;80% involvement. Conclusion: Vitiligo significantly impacts mental health, particularly with greater BSA involvement, leading to heightened depression rates. It is a psychodermatological condition, adversely affecting QOL, highlighting the importance of holistic care in collaboration with mental health professionals.

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm.

The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed. To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo. In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings. The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients. These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.

Clinician-reported outcome measures for the assessment of vitiligo: A scoping review.

Clinician-reported outcome measures (ClinROMs) are essential for assessment of vitiligo in clinical trials and daily practice. Several instruments have been developed and tested to measure, for example, vitiligo extent, repigmentation and activity. The goal of this review was to identify all introductory publications of ClinROMs for vitiligo that include at least some aspects of validation and to describe the instruments' characteristics, intention for use and practical strengths and limitations. A search strategy was conducted in PubMed, Embase and Cochrane Library (CENTRAL) from inception to July 2022. Based on the literature search (n = 2860), 10 articles were identified, describing 14 different ClinROMs. Six ClinRoms measured disease extent and/or repigmentation, seven evaluated disease activity and one was a composite score. The Vitiligo Area Scoring Index (VASI), and Vitiligo Extent Score (VES and VESplus) measure overall disease extent and/or repigmentation. The VASI relies on hand units (1% body surface area), whereas the VES and VESplus use a picture-based scoring technique. The Vitiligo Extent Score for a Target Area (VESTA) measures repigmentation percentage for target lesions. One global assessment score for extent has been validated. Vitiligo disease activity scores included a static measure of clinical activity signs (Vitiligo Signs of Activity Score [VSAS]) and two measures assessing dynamic evolution (Vitiligo Disease Activity Score [VDAS] and Vitiligo Disease Improvement Score [VDIS]). The Vitiligo European Task Force assessment tool (VETFa) is a composite score. Depending on the practical strengths and limitations as well as the research question and setting (clinical trials vs. daily practice), the choice of an appropriate ClinROM may differ. Fourteen ClinROMs in vitiligo were identified to measure vitiligo extent, repigmentation, and activity. Further research evaluating the validity, reliability, and responsiveness of each instrument and worldwide consensus on which instrument to use for a specific outcome (domain) is greatly needed.

Reliability and agreement testing of a new automated measurement method to determine facial vitiligo extent using standardized ultraviolet images and a dedicated algorithm.

Facial repigmentation is the primary outcome measure for most vitiligo trials. The Facial Vitiligo Area Scoring Index (F-VASI) score is often chosen as the primary outcome measure to assess the efficacy of treatments for facial vitiligo. Although useful, this scoring system remains subjective and has several limitations. To assess the agreement and reliability of an algorithmic method to measure the percentage depigmentation of vitiligo on the face. We developed a dedicated algorithm called Vitil-IA® to assess depigmentation on standardized facial ultraviolet (UV) pictures. We then conducted a cross-sectional study using the framework of the ERASE trial (NCT04843059) in 22 consecutive patients attending a tertiary care centre for vitiligo. Depigmentation was analysed before any treatment and, for 7 of them, after 3 and 6 months of narrowband UVB treatment combined with 16 mg methylprednisolone, both used twice weekly. Interoperator and interacquisition repeatability measures were assessed for the algorithm. The results of the algorithmic measurement were then compared with the F-VASI and the percentage of depigmented skin scores assessed by 13 raters, including 7 experts in the grading of vitiligo lesions. Thirty-one sets of pictures were analysed with the algorithmic method. Internal validation showed excellent reproducibility, with a variation of < 3%. The percentage of depigmentation assessed by the system showed high agreement with the percentage of depigmentation assessed by raters [mean error (ME) -11.94 and mean absolute error (MAE) 12.71 for the nonexpert group; ME 0.43 and MAE 5.57 for the expert group]. The intraclass correlation coefficient (ICC) for F-VASI was 0.45 [95% confidence interval (CI) 0.29-0.62] and 0.52 (95% CI 0.37-0.68) for nonexperts and experts, respectively. When the results were analysed separately for homogeneous and heterogeneous depigmentation, the ICC for homogeneous depigmentation was 0.47 (95% CI 0.31-0.77) and 0.85 (95% CI 0.72-0.94) for nonexperts and experts, respectively. When grading heterogeneous depigmentation, the ICC was 0.19 (95% CI 0.05-0.43) and 0.38 (95% CI 0.20-0.62) for nonexperts and experts, respectively. We demonstrated that the Vitil-IA algorithm provides a reliable assessment of facial involvement in vitiligo. The study underlines the limitations of the F-VASI score when performed by nonexperts for homogeneous vitiligo depigmentation, and in all raters when depigmentation is heterogeneous.

Evaluation of Serum Level of Interleukin 15 in Active Vitiligo Compared to Stable Disease and Healthy Control

Abstract Background Vitiligo is a common acquired disorder of depigmentation. Its pathogenesis entails a T helper (TH) 1-cytotoxic T (CT) lymphocytes mediated autoimmune melanocyte destruction. Interleukin (IL)-15 is one of the IL-2 family of cytokines and shares several actions with IL-2. IL-15 enhances survival, maturation, and functional activity of natural killer, neutrophils, and dendritic cells. Furthermore, it potentiates survival, maturation, and cytotoxicity of memory CT cells. IL-15 has been shown to play a crucial role in the pathogenesis of several autoimmune diseases but was poorly investigated in patients with vitiligo. Aims To investigate the role of IL-15 in the pathogenesis of vitiligo. Patients and Methods In total, 40 Patients with vitiligo and 20 controls matched for age and gender were enrolled in the study. Vitiligo Extent Score (VES) and Vitiligo Disease Activity (VIDA) score were used to assess vitiligo severity and activity, respectively. Serum level of IL-15 was assessed by enzyme-linked immune-sorbent assay. Results Serum IL-15 level, in patients with vitiligo, was significantly higher in comparison with the control group (P =. 001). A significant positive correlation was found between serum IL-15 level and VES score (P =. 001) Conclusion IL-15 level was elevated in the sera of patients with vitiligo. IL-15 may therefore have a significant impact on vitiligo autoimmune pathogenesis, and further identification of its molecular roles may highlight new therapeutic strategies for vitiligo.

Comparative Analysis of the Most Used Versus the Recently Developed Vitiligo Activity and Extent Scores and Their Change with Treatment.

There are diverse assessment tools for vitiligo, with no standardized approach that helps unify treatment outcome measures. Thus, comparing different treatment modalities and developing evidence-based recommendations for vitiligo management has been quite challenging. We compared the most commonly used tools assessing both vitiligo activity and extent, namely, Vitiligo Disease Activity Score (VIDA) and Vitiligo Area and Severity Index (VASI) score to their newly developed counterparts, namely, Vitiligo Extent Score Plus (VES plus) and Vitiligo Signs of Activity score (VSAS), to provide insights that would help set recommendations for a unified outcome assessment protocol for vitiligo patients. Thirty-six active non-segmental vitiligo cases were recruited, 30 of whom completed 48 sessions of narrow band ultraviolet B (NB-UVB). Patients were assessed for both extent and activity both before and after treatment with NB-UVB. Scores were correlated. Additionally, VES plus was assessed for its reliability in comparison to VASI score. Both extent (VASI and VES plus) and activity scores (VIDA and VSAS) showed significant improvement following treatment. Additionally, VES plus and VASI were positively correlating both before and after treatment as well as their percent change. Furthermore, VES plus proved as reliable as VASI. Regarding activity scores, total, hypochromic and Koebner VSAS only correlated with VIDA following treatment. Confetti VSAS neither correlated with VIDA before nor after treatment. VES plus and VASI scores have proven of comparable reliability. While examination-based VSAS score comes as an additive tool to the history-based VIDA score.

Assessment of serum interleukin-13 level in vitiligo patients and its correlation to disease severity

Background Vitiligo is a chronic depigmenting skin disease that has a prevalence of 0.5–2% of the population worldwide. Cytokines have a regulatory role in the immune response and depigmentation process in vitiligo. There is an imbalance of various types of cytokines in vitiligo patients. Interleukin-13 (IL-13) plays a role in many autoimmune diseases. Objective To measure the serum level of IL-13 in vitiligo patients and detect its correlation with disease severity. Patients and methods This is a case–control study including 20 randomly chosen patients with nonsegmental vitiligo and 20 healthy controls. Vitiligo disease activity score was assessed in all patients. Serum level of IL-13 was measured by enzyme-linked immunosorbent assay. Results This study revealed that the mean serum level of IL-13 was significantly higher in vitiligo patients, and there was negative correlation between serum level of IL-13 and vitiligo extent score but not statistically significant. Conclusion IL-13 might have a role in the pathogenesis of vitiligo and might play a protective role in the disease. Further large-scale studies are needed to confirm the definite role of IL-13 in vitiligo pathogenesis.

Facial involvement is reflective of patients' global perception of vitiligo extent.

The involvement of visible areas in vitiligo has been found to be correlated with increased psychiatric morbidity. Although multiple tools have been developed to assess vitiligo, no cutoff for improvement or worsening of vitiligo from a patient's perspective has been established. To determine the minimal clinically important difference (MCID) of the Self-Assessment Vitiligo Extent Score (SA-VES) in patients with vitiligo and to evaluate, from the patient's perspective, the importance of the change in the involvement of visible areas (face and hands) in patients' overall perception of disease worsening or improving. This was a cross-sectional study in the context of the ComPaRe e-cohort. Adult patients with vitiligo were invited to answer online questionnaires. They completed the SA-VES twice, 1 year apart. In addition, patients answered a 5-point Likert anchor question aimed at assessing their perception of the evolution of the extent of their vitiligo. The MCID was calculated using distribution- and anchor-based approaches. Using ordinal logistic regression, the change of vitiliginous lesions on the face or hands was compared to the overall extent of vitiligo (patches on all body areas). In total, 244 patients with vitiligo were included in the analyses; 20 (8%) were found to have an improvement in their vitiligo. The MCID in worsened patients was equal to a 1.3% body surface area [95% confidence interval (CI) 1.01-1.43] increase in the SA-VES. For participants with improved vitiligo, the MCID was equal to a decrease in total SA-VES of 1.3% (95% CI 0.867-1.697). Patients' perceptions of change in their vitiligo was increased sevenfold when it affected the face vs. the rest of the body. Changes in the facial SA-VES were highly correlated with patients' impressions of the extent of vitiligo.

Ayurvedic management of Shvitra (~vitiligo): A case report

Abstract: Vitiligo, a depigmenting disorder affecting 1%–2% of the world’s population, is a chronic skin disease, characterized by the appearance of white depigmented macules and patches due to loss of melanocytes. In Ayurveda, it is referred to as Shvitra or Kilasa and cited under the category of Kushta rogas (~skin diseases). Shvitra (~vitiligo) is classified as Daruna (~reddish discolored lesions), Aruna (~coppery color discolored lesions), and Kilasa (~whitish discolored lesions) consequence affliction of Rakta (~blood tissues), Mamsa (~muscle tissues), and Meda (~fat tissues), respectively. A 10-year-old female patient presented to the outpatient department with white discoloration of the skin and spreading on the entire body including the face, neck, hands, back, shoulders, abdomen, and legs for the last seven years. The patient was treated with Ayurvedic oral medications including Navayasa lauha, Manjistha, Krimimudgar rasa, Kakoudumbar, Shvitrari lepa, and Brihatyadi kashayam along with specific instructions on diet and lifestyle. After treatment, about 61% improvement in Vitiligo Extent Score has been noticed. This case report provides evidence of Ayurveda treatment approaches in the management of skin ailments such as Shvitra.

What is the quality of life of adults with vitiligo in Mexico?

Vitiligo is an incurable, slowly progressive skin condition, the prevalence of which ranges from 0.4 to 2.0%. Health-related quality of life (HRQoL) refers to self-perceived well-being associated with the presence of a disease and its treatment. Cross-sectional study at a dermatological center. Adults with non-segmental vitiligo (NSV) were included, while patients with other pigmentary disorders and other types of vitiligo were excluded. The VitiQoL questionnaire (0 = no skin involvement, 90 = maximum skin involvement), the Vitiligo Extent Score (VES) and the Vitiligo Area Scoring Index (VASI) were applied. 492 patients did participate; 63% were women. An average score of 32.6 was obtained on VitiQoL (95% CI = 30.6-34.5). Self-perception of severity and HRQoL were correlated (r = 0.568, p < 0.001). Age, the female gender, lower education and higher self-perceived severity were associated with poorer HRQoL. The proportion of subjects who reported an addiction was similar in the worst and best HRQoL groups (28% vs. 32%, p = 0.23). Poorer HRQoL is explained by severity self-perception, concern about disease progression, appearance of the skin and necessary actions to avoid sun exposure during recreation.

Use of the Vitiligo Extent Score: a protocol for a scoping review

IntroductionVitiligo is a chronic skin condition with no cure. Clinical assessment and treatment evaluation relies heavily on clinometry tools and expert knowledge. The Vitiligo Extent Score has been proposed as...

Quality of life in children and adolescents with vitiligo

Abstract The assessment of the quality of life (QoL) in vitiligo patients is essential to quantify the psychological burden of the disease. The effect of vitiligo on the QoL has been reported extensively in adults; however, there is a lack of information in Mexican children. To assess the QoL in children and adolescents with vitiligo and their association with affected body surface area (BSA) and age. A cross-sectional study was conducted in vitiligo patients aged between 5 and 17 years. The study was approved by our institutional review board and informed consent was obtained from all participants and their parents. Participants with psychiatric and neurological disease were excluded. Vitiligo was clinically diagnosed by an experienced dermatologist, and the following variables were registered: sex, age, origin, education, treatment, time and response to treatment, age of onset, clinical type, affected body areas and skin phototype. All participants were requested to complete the CDLQI questionnaire, those aged from 5 to 10 years filled the cartoon format and those from 11 to 17 years filled the text version. The measure of the disease extent was done using the Vitiligo Extent Score (VES). A total of 223 participants were recruited, 102 males (46·2%) and 120 females (53·8%) with a mean age of 9·86 (SD 3·02) years. The mean age of onset of vitiligo was before the first decade of life, of 7·12 (SD 3·66) years. The most frequent type of vitiligo was nonsegmental 53·8% (n = 120), followed by segmental 46·2% (n = 103). The most affected area was head 63·7% (n = 142), followed by trunk 56·1% (n = 125). The median of body surface affected area was 0·7797 with a minimum of 0·0060 and a maximum of 22·285, of these 84·3% (n = 188) had lesions that covered &amp;lt;1% of the BSA and 15·7% (n = 35) &amp;gt;1% BSA. Phototype III was the most frequent in half of the population, followed by phototype IV. The mean duration of the treatment was 11·32 (SD 18) months; 62·3% (n = 139) of them showed good response to treatment. The mean value of the CDLQI questionnaire was 4·95 (SD 4·57) points, with a minimum of 0 and a maximum of 30 points. The participants were classified according to CDLQI results in the following groups: 22·9% (n = 51) showed no effect of vitiligo in their QoL, 50·7% (n = 113) had a small effect, 19·3% (n = 43) a moderate effect, 4·9% (n = 11) a very large effect and only 2·2% (n = 5) an extremely large effect. A total CDLQI score between 0 and 9 was obtained from 85·2% (n = 190) of the participants and 14·8% (n = 33) had a score &amp;gt;10 points. Differences between subgroups were found; children older than 10 years had a lower CDLQI score (mean of 4·13 points), and children under this age had a higher CDLQI score (mean of 5·54 points), and this difference was significant, P = 0·026. Regarding the affected BSA, patients with CDLQI in ranges between 0 and 9 points had a median VES index of 0·1905, while children with CDLQI &amp;gt;10 points had a median VES index of 0·4781, P = 0·024. No significant differences were found when we analysed the rest of the variables in relation to quality-of-life results. The effect of vitiligo on the QoL in Mexican children and adolescents with vitiligo was similar to that of previous studies. We found a higher prevalence of patients with moderate effect on the QoL. The lower the age and the BSA affected, the greater the impact on the QoL.