Vitiligo Area Scoring Index Score Research Articles

Role of Serum IFN-γ and IL-10 as Predictive Biomarkers of Vitiligo Disease Activity: A Case-Control Study

Abstract Background and Objectives: IFNγ is a pleiotropic cytokine and through the regulation of immunologically relevant genes, they coordinate a wide range of cellular programs.[1] As a potent pro-inflammatory cytokine, it plays a pivotal role to induce depigmentation in vitiligo. In this study, we aim to assess the role of IFNγ in the activity, duration and extent of the disease and the antagonistic action of IL-10 is also assessed in vitiligo. Materials and Methods: A case-control study was conducted with 100 study participants with 50 cases clinically diagnosed as Vitiligo and 50 controls. All patients underwent complete evaluation with detailed demographic parameters, history and physical examination. The severity of the disease was assessed clinically by Vitiligo Area Scoring Index (VASI) and Vitiligo Disease Activity Score (VIDA). And blood investigations done were IFN-γ and IL-10. Results: We observed significantly higher levels of serum IFNγ levels in the patient group when compared with those of the normal controls (p=0.002) and showed a positive correlation with the activity and severity of the disease with a significant VASI (p=0.05) and VIDA score (p=<0.001). The mean serum IL-10 (p<0.001) in patients with vitiligo was significantly lower than that in the control group. Conclusion: This study showed significantly high serum levels of IFN-γ and correspondingly low levels of IL-10. New strategies, such as the combination of IFNγ blockade with inhibition of other signalling pathways, may further improve IFNγ targeted immunotherapy of the disease.

The efficacy of bimatoprost ophthalmic solution combined with NB-UVB phototherapy in non-segmental and segmental vitiligo: a single-blind randomized controlled study

Bimatoprost ophthalmic solution 0.03% (PGF2α analogues) combined with narrowband ultraviolet B (NB-UVB) was reported to be an effective treatment for vitiligo. To investigate the efficacy and safety of treatment for non-segmental/segmental vitiligo compared among bimatoprost ophthalmic solution 0.01% combined with NB-UVB phototherapy, bimatoprost monotherapy, and placebo. This single-blind randomized controlled study enrolled stable Thai vitiligo patients with at least three similarly sized lesions in the same anatomical area. The treatment duration was 6 months with 1- and 2-month post-treatment follow-ups. The 3 selected lesions on each patient were randomized to receive combination therapy, monotherapy, or placebo. The Vitiligo Area Scoring Index (VASI) was used to evaluate lesion response. Of the 25 initially enrolled subjects, 19 patients were analyzed. There were 13 and 6 non-segmental and segmental vitiligo cases, respectively. Eight and 11 cases had face/neck and non-face/neck lesions, respectively. Non-segmental vitiligo and non-face/neck vitiligo patients in the combination group had significant improvement in VASI score at 3 months, 6 months, and at the 2-month follow-up. No side effects were observed/reported. Bimatoprost combination therapy was shown to be safe and effective for treating Thai patients with non-segmental vitiligo in non-face/neck areas of the body.

Implementation of the vitiligo area scoring index in clinical studies of patients with vitiligo: a scoping review.

The vitiligo area scoring index (VASI) is a validated, reliable clinician-reported outcome measure widely used to assess the extent of skin depigmentation seen in patients with vitiligo and to measure patient responses to therapies for vitiligo in clinical trials. However, its implementation in studies is inconsistent and makes comparing results across different studies difficult. The aim of this scoping review is to summarize interventional clinical studies that applied the VASI to measure vitiligo and identify variability in VASI implementation. A systematic search of Ovid Medline, Embase, Web of Science, Cochrane, and ClinicalTrials.gov was performed. Interventional studies published between January 1946 and October 2020 that used the VASI as an outcome measure for assessing vitiligo response were reviewed for methodological approach. Great heterogeneity was found within the 55 included interventional studies that used VASI as an outcome measure. A total of 9 VASI subtypes were described by the authors within 10 intervention categories. VASI determined study eligibility in one study. Body surface area was most frequently established using inconsistent methods. We found unclear or ambiguously scaled assessments of depigmentation. Most VASI outcomes were reported as mean absolute difference, percentage VASI improvement, and percentage of patients who achieved the VASI endpoint. The VASI score was over 100 in one study. Our scoping review revealed many VASI methodology variations in interventional clinical studies of vitiligo. While VASI is a standard method to measure vitiligo changes, substantial heterogeneity in methodology limits reliable comparison and interpretation of findings from different clinical trials. Our findings may be used as a foundation to standardize the VASI outcome measure methodology, allowing for improved clinician training and rigorous data analysis across vitiligo research groups worldwide.

Apremilast Add-On Benefits Over Conventional Drugs (ABCD) in Unstable Non-segmental Vitiligo: A 12-Week Single-Center Randomized Controlled Trial.

Background Apremilast is an oral phosphodiesterase-4 enzyme inhibitor that modulates the immune system by increasing intracellular cyclic adenosine monophosphate levels and inhibiting inflammatory cytokines synthesis. We aimed to compare the efficacy and safety of add-on apremilast in combination therapy with standard treatment in patients with unstable, non-segmental vitiligo. Methods The study was a 12-week randomized, controlled, parallel-group, open-labeled trial.The control group received standard treatment (n=15), and the intervention group received 30 mg apremilasttwice daily in addition to standard treatment (n= 16). Time to the first sign of re-pigmentation, halt in progression, and change invitiligo area scoring index (VASI) score is the primary outcomes. Normality was assessed, and appropriate parametric and nonparametric tests were undertaken. Results Thirty-seven participants were randomized into two groups, and analysis was done on thirty-one participants. Over the treatment duration of 12 weeks, the median time to observe the first sign of re-pigmentation was four weeks in the add-on apremilast group compared to seven weeks in the control group (p=0.018). The halt in progression was observed more in the add-on Apremilast group (93.75%) compared to the control group (66.66%) (p=0.08). The VASI score decreased by 1.24 in the add-on apremilast group and 0.05 in the control group (p= 0.754). Parameters including body surface area, dermatology life quality index, and body mass index reduced significantly, while the visual analog scale increased significantly in the add-on apremilast group. However, results were comparable between groups. Conclusions Treatment with add-on apremilast accelerated clinical improvement. It also reduced disease progression and improved the disease index among participants. However, add-on apremilast had a lower tolerability profile than the control group.

Vitiligo: Correlation with Cytokine Profiles and its Role in Novel Therapeutic Strategies: A Case-Control Study.

The inflammatory and immune factors play a key role in the pathogenesis of vitiligo, and there are very few studies that have investigated the levels of major cytokines produced by T helper (Th) 1, Th2, and Th17 cells. This can enable better understanding of the, pathogenesis, and severity of vitiligo. To evaluate the serum levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-1β, interferon (IFN)-γ, and IL-10 in patients with vitiligo and to correlate them with the disease severity and activity and to compare them with normal healthy controls. A case-control study was conducted with 100 study participants: 50 cases clinically diagnosed as vitiligo and 50 controls. All patients underwent complete evaluation with detailed demographic parameters, history, and physical examination. The severity of the disease was assessed clinically by Vitiligo Area Scoring Index (VASI) and Vitiligo Disease Activity Score (VIDA). Blood investigations performed were IL-6, TNF-α, IL-1β, IFN-γ, and IL-10. We observed significantly higher levels of serum IFN-γ levels in the patient group when compared with those of the normal controls (P = 0.002) and showed a positive correlation with the activity and severity of the disease with a significant VASI (P = 0.05) and VIDA score (P = < 0.001). The mean serum IL-10 (p < 0.001) in patients with vitiligo was significantly lower than that in the control group. There was no significant difference in the serum level of TNF-α level (P = 0.347), IL-6 (P = 0.365), and IL-1β (P = 0.362) between vitiligo and healthy controls. This study proved that high serum level of IFN-γ may be a risk factor for vitiligo progression and significantly low levels of IL-10, which has an anti-inflammatory role, suggesting that they could be used as a marker for assessing vitiligo activity and may open the way for further therapeutic approaches for vitiligo.

Meaningful Changes in What Matters to Individuals with Vitiligo: Content Validity and Meaningful Change Thresholds of the Vitiligo Area Scoring Index (VASI).

IntroductionThis study explored patients’ and dermatologists’ priority outcomes for treatment to address, clinical outcome assessments (COA) for use in vitiligo clinical trials, and perceptions of within-patient meaningful change in facial and total body vitiligo.MethodsSemistructured, individual, qualitative interviews were conducted with patients living with non-segmental vitiligo in the USA and with expert dermatologists in vitiligo. Concept elicitation discussions included open-ended questions to identify patient priority outcomes. Vitiligo COAs were reviewed by dermatologists. Tasks were completed by patients to explore their perceptions of meaningful changes in vitiligo outcomes; dermatologists’ opinions were elicited. Data were analyzed using thematic methods; meaningful change tasks were descriptively summarized.ResultsIndividuals with vitiligo (N = 60) included adults (n = 48, 63% female) and adolescents (n = 12, 67% female). All Fitzpatrick Skin Types were represented. Eight (13%) were first- or second-generation immigrants to the USA. Expert dermatologists (N = 14) participated from the USA (n = 8), EU (n = 4), India (n = 1), and Egypt (n = 1). All individuals with vitiligo reported experiencing skin depigmentation; an observable clinical sign of vitiligo. Most confirmed that lesion surface area (n = 59/60, 98%) and level of pigmentation (n = 53/60, 88%) were important to include in disease assessments. Following an explanation, participants (n = 49/60, 82%) felt that the Facial Vitiligo Area Scoring Index (F-VASI) measurement generally made sense and understood that doctors would use it to assess facial vitiligo. Most participants felt that a 75% (n = 47/59, 80%) or 9 0% improvement in their facial vitiligo would be indicative of treatment success (n = 55/59, 93%). In the context of evaluating a systemic oral treatment for vitiligo, dermatologists perceived a 75% improvement on the F-VASI as successful (n = 9/14, 64%). Regarding the Total VASI (T-VASI) score, n = 30 participants considered 33% improvement as treatment success; an additional n = 10 endorsed 50% improvement and a further n = 5 endorsed 75% improvement. Clinicians most frequently identified 50% (n = 6/14, 43%) or 75% (n = 4/14, 29%) improvement in T-VASI as successful.ConclusionRepigmentation is a priority outcome for patients. The VASI was considered an appropriate tool to assess the extent of vitiligo. A minimum 75% improvement from baseline in the F-VASI and minimum 50% improvement from baseline in the T-VASI were identified as within-patient clinically meaningful thresholds.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00752-8.

A Comparative Study of Efficacy of Miniature Punch Grafting and Platelet Rich Plasma Therapy in Treatment of Focal Stable Vitiligo in 50 Cases

Introduction: Vitiligo, a depigmented skin disorder is characterized by selective loss of melanocytes, which in turn leads to pigment dilution in the affected areas of the skin. The characteristic lesion is a totally amelanotic, non scaly, chalky white macule with distinct margins. If the disease is not progressing for the past one year it is described as stable vitiligo. There are various treatment options available for the treatment of focal stable vitiligo. It can be safely treated with miniature punch grafting as well as platelet rich plasma therapy. Aims and Objectives: Aim of this study is to compare efficacy of miniature punch grafting and platelet rich plasma therapy and to evaluate the outcome of treatment of focal stable vitiligo. Materials and Methods: Total 50 patients were selected and divided into two groups. One group was treated with miniature punch grafting while the other group underwent platelet rich plasma therapy. Pre-treatment and post treatment assessment was done by VASI (Vitiligo area scoring index) score. Result: A total of 25 patients were selected for grafting. Perigraft pigmentation was evident from 3rd week of grafting steadily increasing up to the end point of record i.e 6months. 17 patients showed good response, 4 patients showed average response while 4 patients showed poor or no response at all. Out of the 25 patients taken for platelet rich plasma therapy, 7 patients showed good response, 7 patients showed average response while 11 patients showed poor or no response at all. Conclusion: Miniature punch grafting showed better response as compared to platelet rich plasma therapy but both the therapies have their pros and shortcomings. Keywords: Vitiligo, miniature punch grafting, platelet rich plasma, VASI.

Homoeopathic treatment of vitiligo: an open observational pilot study

Background: Vitiligo is a common hypopigmentation disorder with significant psychological impact. An evaluation of homeopathic treatment was performed in individuals with vitiligo in a hospital outpatient clinic in West Bengal, India. Methods: Thirty participants (median age 27 years old, 57% female) were recruited for a prospective open-label pilot study and treated with individualized homeopathic medicines for 6 months. Efficacy was assessed after 3 months and 6 months using Vitiligo Area Scoring Index (VASI) score, Vitiligo European Task Force (VETF) score, and Dermatological Life Quality Index (DLQI) score, which are validated outcome measures evaluating the area, intensity, spread of depigmentation of vitiligo lesions, and quality of life (QoL). Results: A total of 27 participants completed the trial; 3 dropped out. After 6 months of treatment, the median VASI total score improved significantly by 0.1 units (p=0.003), from 0.8 (0.5, 1.5) to 0.7 (0.3, 0.8) on a scale from 0 (no depigmentation) to 100 (completely depigmented). Similarly, the VETF median score improved by 2 units (p=0.0001) from 1 (0, 1) to –1 (–1, 0) and the staging score changed from 1 (1, 2) to 1 (0, 1), p=0.002. The total DLQI median score exhibited significant reduction from 21 (17, 22) to 13.6 (10, 17), change 7.4 (p=0.0001), as also did its components. Conclusions: Individualized homeopathic treatment associated with significant improvement of VASI, VETF and DLQI scores. The extent to which the observed effects were due to placebo needs clarification in future randomized double-blind clinical studies preceded by feasibility studies.&#x0D; Trial Registration: Clinical Trials Registry, India registration number CTRI/2013/08/003879.

Efficacy and safety of automated epidermal micrograft in patients with stable segmental and nonsegmental vitiligo.

Vitiligo is a common, psychologically devastating pigmentary disorder. Surgical graftings are used to treat stable vitiligo when medical treatment fails. An automated epidermal micrograft harvesting (AEMH) system was first designated to treat wounds, and very few studies investigated the application of AEMH in vitiligo. In this study, we investigated the efficacy and safety of the AEMH system in patients with stable segmental and nonsegmental vitiligo. The rate of repigmentation and adverse events was recorded bimonthly for at least 12months. We analyzed the efficacy based on patient characteristics, vitiligo subtypes, and different anatomical locations. A total of 56 depigmented lesions from 34 patients were included. 95.50% of the automated epidermal micrografts were successfully grafted at the recipient sites. There was a significant improvement in Vitiligo Area Scoring Index (VASI) and Dermatologic Life Quality Index (DLQI) in patients treated with AEMH (p<0.001). The rate of repigmentation by VASI score improves from 96.25±8.59 to 48.30±28.16 after the treatment (p<0.001). Treatment outcomes were comparable between the patients of segmental and stable nonsegmental vitiligo. The face and neck region achieved a better outcome, followed by the trunk (chest, abdomen, back, and axilla), limbs, and the worse outcome was found in the acral region (p<0.014). Conclusively, AEMH is an effective treatment procedure with limited adverse events in patients with stable vitiligo. This harvesting method may be a feasible option for vitiligo surgical treatment.

25486 Correlation of the Vitiligo Area Scoring Index with patient- and physician-reported measures of clinical improvement in a randomized, double-blind phase 2 study

The Vitiligo Area Scoring Index (VASI) is a quantitative clinical tool that estimates the overall area of vitiligo patches (ie, skin depigmentation) and the degree of macular repigmentation within these patches over time. This analysis aimed to evaluate the correlation between facial and total VASI (F-VASI and T-VASI, respectively) with patient- and physician-reported measures of clinical improvement (Patient Global Impression of Change-Vitiligo [PaGIC-V; 7-point scale] and Physician’s Global Vitiligo Assessment [PhGVA]) in a randomized, double-blind phase 2 study of 157 patients with vitiligo. Among stable patients (ie, no change from baseline in PaGIC-V [score of 4]), VASI scores showed excellent test-retest reliability (≥0.95) at Weeks 12 and 24. Significant differences in VASI were detected among PhGVA categories (mild, moderate, severe) at baseline. The VASI detected change in disease status during the treatment period; the changes were significantly different between patients who showed improvement (PaGIC-V, 1-3) or worsening (PaGIC-V, 5-6) and were related to the PaGIC-V (Pearson’s r ∼0.45, P ˂ .0001). To assess interpretability, an anchor-based approach used PaGIC-V (score of 1 or 2) to define clinically meaningful change (CMC) on the VASI at Week 24; mean percentage CMC was 57% for F-VASI and 42% for T-VASI. Results indicated that a higher percentage of patients treated with 1.5% ruxolitinib cream met or exceeded CMC thresholds vs vehicle on F-VASI (39.4% vs 3.1%; P = .0005) and T-VASI (27.3% vs 0%; P = .002). Analyses of efficacy using the F-VASI and T-VASI reflect meaningful and relevant changes in patients with vitiligo.

Add-on Psoralea corylifolia mother tincture external application to individualized homeopathic medicines in treatment of vitiligo: Open, randomized, pragmatic, pilot trial

BackgroundVitiligo causes patchy hypo-pigmentation of skin and mucous membrane, with cosmetic and psychological effects. Studies suggest Psoralea corylifolia (PC) has pigmentor properties and that individualized homeopathic medicines (IH) are a promising treatment option in vitiligo. This pilot trial was aimed at testing the feasibility of a future definitive trial comparing the effects of three treatment regimens – 1. IH, 2. PC mother tincture (MT) external application, and 3. IH and PC (IHPC) in the treatment of vitiligo. MethodsAn open, randomized (1:1:1), three parallel arms, pragmatic, pilot trial was conducted on 60 patients at the dermatology and Materia Medica outpatients of National Institute of Homoeopathy (NIH), India. Primary outcome was Vitiligo Area Scoring Index (VASI); and secondary outcomes were Vitiligo Quality of Life (VitiQoL) and Dermatological Life Quality Index (DLQI); assessed at baseline, 3rd month and 6th month. Intention-to-treat analysis was performed; intra-group and inter-group comparisons were made by Friedman and Kruskal-Wallis tests respectively. ResultsFive patients dropped out (IH: 2, PC: 2, IHPC: 1). Intra-group changes over 3 and 6 months were mostly statistically significant in all 3 outcomes (P < 0.001). No significant differences were observed in VASI and DLQI total scores among the three groups over either 3 or 6 months. Differences among groups after 3 and 6 months showed statistical significances in VitiQoL total scores (P = 0.038 and 0.037 respectively) favoring PC and IHPC respectively. ConclusionA definitive trial appears feasible. All three regimens appeared equally effective and safe, though a small positive direction of effect towards PC and IHPC was observed. As a pilot trial, no definite conclusions could be drawn. Trial registration: CTRI/2018/04/013446.

DEFB1 gene polymorphisms modify vitiligo extent and response to NB‐UVB phototherapy

Human beta defensin-1(hBD-1); an antimicrobial peptide, has immune regulatory effects which may be involved in autoimmunity. The aims were to evaluate the association between defensin beta 1 (DEFB1) (-44 C/G) and (-20 G/A) gene polymorphisms with the risk of vitiligo development, the extent of the disease and the response to NB-UVB treatment in a sample of Egyptian population. 178 active nonsegmental vitiligo patients and 182 control subjects were included in this prospective case control study. Vitiligo extent was evaluated using vitiligo area scoring index (VASI). Gene polymorphisms in all participants were studied by RFLP PCR technique. Patients were treated by three narrowband UVB (NB-UVB) treatment sessions per week. After 12 weeks, the patients were reevaluated clinically to assess the extent of the disease using VASI scoring again and to evaluate the type of repigmentation, if any. AA genotype of DEFB1 (-20G/A) has a protective role against vitiligo development, while (DEFB1 -44 C/G) GG genotype and G allele increase the risk of vitiligo development about two folds. Patients carrying polymorphism in DEFB1 (-20G/A) only showed the lowest VASI scores (14.23 ± 2.77) and the highest percentage of improvement (66.12 ± 18.01%), while patients carrying polymorphism in DEFB1(-44 C/G) only showed the highest baseline VASI scores (38.87 ± 6.7) and the lowest therapeutic response (23.79 ± 19.42%) among all patients groups. Different DEFB1 gene polymorphisms may modify the risk of vitiligo development, the disease extent and the response to NB-UVB phototherapy.

The Impact of Vitiligo on Patients' Psychological Status and Sexual Function: Cross-Sectional Questionnaire-Based Study

Introduction: Vitiligo is a chronic pigmentary cutaneous disorder. Although vitiligo is not a life-threatening disease, it seriously affects patients' psychological status and Quality-of-Life (QoL). Moreover, the effect of vitiligo on genital image severely affects sexual function, especially in females. Patients &amp; Methods: This cross-sectional questionnaire-based study had targeted patients with vitiligo of both genders. 173 patients who had responded to the given questionnaires were included and their responses were statistically analyzed. Patients’ files were revised for extraction of demographic and clinical data and the previous evaluation of the Vitiligo Area Scoring Index (VASI) score. Results and Discussion: Median VIS-22 score was in the range of 21-49, but 109 patients had a median score of 28. Seventy-eight patients had mild and 15 patients had moderate depression. Regression analysis defined the sense of being unattractive, disappointed in self and discouragement about the future as the most significant underlying causes of depression. Ninety-two patients had sexual dysfunction and scoring of satisfaction by the sexual act was the highest while scoring for the desire was the lowest. Regression analysis revealed that female gender, high ASEX and VASI scores are the significant predictors for high BDI-II. ROC curve analysis defined a high ASEX score as a significant predictor for a high BDI-II score. Conclusion: The obtained results indicated a deleterious effect of vitiligo on patients’ psychological status that may progress to depression. The effects of the disease on body image, especially the genital area, induced sexual dissatisfaction with an impact on sexual function. Altogether, raise a suggested adjuvant role for psychotherapy in patients with vitiligo which might even indirectly lead to improvement of vitiligo.

Outcomes of autologous non-cultured melanocyte keratinocyte transplantation in vitiligo and nevus depigmentosus

Background Melanocyte-keratinocyte transplantation procedure (MKTP) is an effective surgical technique for restoring skin pigmentation in all types of vitiligo and leukoderma patients who are unresponsive to medical and/or phototherapy treatment. Data specific to the outcomes of MKTP among Thai vitiligo and nevus depigmentosus patients are currently scarce. Objectives To evaluate the efficacy and safety of MKTP in patients with vitiligo or nevus depigmentosus at the short-term (≤6 months) and long-term (≥12 months) follow-up. Materials and methods A retrospective review of the medical records of vitiligo or nevus depigmentosus patients who underwent MKTP at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during 2016 to 2019 was conducted. Repigmentation outcomes were evaluated by Vitiligo Area Scoring Index (VASI). Results Twenty-five patients had 27 MKTP surgeries on 32 anatomically-based lesions. The mean age was 32.4 years, the mean age at onset was 25.5 years, and 19 patients were male. Segmental vitiligo, non-segmental vitiligo, and nevus depigmentosus had significantly improved VASI scores at the short-term follow-up (−74.2% ± 23.2%, −100%, and −62.5% ± 17.6%, respectively) and the long-term follow-up (−81% ± 27.7%, −95.0% ± 7.0%, and −83.3% ± 14.4%, respectively). Conclusion MKTP is a safe and effective method for treating refractory vitiligo and nevus depigmentosus in Thai patients.

Topical latanoprost solution in combination with microneedling in treatment of segmental vitiligo

Background Vitiligo is a depigmenting disorder of the skin and mucous membranes. Latanoprost (LT) is a prostaglandin F2α analog used in the treatment of glaucoma and was found to induce skin pigmentation. Aim This comparative study aims to assess efficiency of topical 0.005% LT solution in combination with microneedling for treatment of segmental vitiligo. Patients and methods The authors addressed 50 patients with segmental vitiligo stable for at least one year divided into two groups in this study: group A included 25 patients treated with topical 0.005% LT solution in combination with microneedling sessions by using dermapen, and group B included 25 patients who were treated with topical 0.005% LT solution alone without microneedling. The response to treatment was evaluated by serial photographs, degree of pigmentation, and vitiligo area scoring index (VASI). All patients were evaluated before the start of the treatment and each month after the end of the treatment. Results The group A, which was treated by combination of topical 0.005% LT ophthalmic solution and microneedling, showed significant improvement in VASI score, whereas group B, which was treated by topical 0.005% LT ophthalmic solution alone without microneedling, showed minimal improvement in VASI score. Conclusion The use of microneedling in combination with using topical LT improves the results of treatment of segmental vitiligo.

The efficacy of combining fractional CO2 laser and tacrolimus ointment in the treatment of vitiligo

Background Treatment of vitiligo is very challenging. Topical tacrolimus is one of the topical modalities reported to be successful. No single treatment, however, gives on its own satisfactory results, and combination treatments offer better outcomes. Fractional CO2 laser (FCO2) has been recently studied as an adjuvant treatment with other modalities in vitiligo. Objective To evaluate the value of adding FCO2 laser before tacrolimus ointment in vitiligo. Patients and methods This is a randomized controlled prospective clinical trial including 27 patients with stable vitiligo with a total of 152 lesions. Lesions on one side of the body received one session of FCO2 every month for 3 months in addition to tacrolimus ointment twice daily for 3 months, whereas lesions on the other side of the body received tacrolimus ointment only. Results Lesions treated with the combination modality showed improvement in 17 (22.36%) lesions, with a mean reduction in Vitiligo Area Scoring Index (VASI) of 10.05%, whereas lesions treated with tacrolimus only showed improvement in 13 (17.1%) lesions, with a mean reduction in VASI of 5.535%, yet these differences were not statistically significant (P=0.46 and 0.24, respectively). Acral lesions showed significantly more reduction in VASI when treated with combination therapy than with tacrolimus only (P=0.034). Lesions with shorter duration showed significant more reduction in VASI scores when treated with the combination (P=0.024). Conclusion Treatment of stable vitiligo with FCO2 before tacrolimus yields mild improvement, statistically not significantly better than tacrolimus only except in acral areas. Lesions of shorter duration show significantly better response to the combination treatment than to tacrolimus only.

Assessment of antimelanocyte antibodies in patients of vitiligo

Introduction: Vitiligo is a non contagious acquired pigmentation disorder characterized by sharply defined white patches of variable shape and dimensions, increasing in size and number with time. The present study assessed anti-melanocyte antibodies (AMAs) in patients of vitiligo. Materials & Methods: The present study was conducted on 72 cases of vitiligo of both genders. The severity of vitiligo was assessed according to the Vitiligo Area Scoring Index (VASI). AMA was measured by human melanocyte antibody enzyme-linked immunosorbent assay (ELISA) Kit. Results: In group I (cases), there were 40 males and 32 females and in group II (control), there were 34 males and 38 females. The mean VASI score in males was 8.13 and in females was 8.45, duration of disease was 6.24 years in males and 6.17 years in females. The difference was significant (P

Treatment outcome and persistence of repigmentation from narrow-band ultraviolet B phototherapy in vitiligo

Background: Narrow-band ultraviolet B (NB-UVB) phototherapy is a mainstay treatment in vitiligo. However, data relative to repigmentation outcome, prognostic factors, and duration of repigmentation are limited.Objectives: To investigate the quantitative repigmentation outcome of NB-UVB phototherapy in vitiligo, the factors associated with favorable prognosis after NB-UVB, and the duration of repigmentation after NB-UVB discontinuation.Materials and methods: Medical records of vitiligo patients who underwent NB-UVB phototherapy at Department of Dermatology, Siriraj Hospital during 2012 to 2016 were retrospectively reviewed. Repigmentation was assessed using Vitiligo Area Scoring Index (VASI) score.Results: Fifty-eight patients were included. All patients received NB-UVB phototherapy twice to three times weekly for a median duration of 12 months. Forty-two patients had nonsegmental vitiligo (NSV), and 16 had segmental vitiligo (SV). NSV and SV demonstrated overall improvement in VASI score of –50.0%±31.0% and −40.0%±28.3%, respectively. Factors predictive of good outcome included type of vitiligo, lesion location, disease duration before NB-UVB, and duration and total number of NB-UVB treatments. Persistence of repigmentation was observed in approximately 80% of cases at one year after discontinuation of NB-UVB.Conclusion: NB-UVB phototherapy is an effective treatment for vitiligo, especially NSV. Repigmentation persisted in 80% of patients at 1 year after cessation of phototherapy.

Plasma Thiol Levels are Associated with Disease Severity in Nonsegmental Vitiligo.

Background:Vitiligo is a depigmenting cutaneous disorder with complex pathogenesis. Thiol compounds are well-known organic structures that play a major role in melanogenesis.Aim:The aim of this study was to determine the association between plasma thiol level and disease severity in patients with nonsegmental vitiligo.Methods:A total of 73 patients with nonsegmental vitiligo (57 generalized and 16 localized type) and age- and sex-matched 69 healthy controls were enrolled in the study. Plasma levels of native thiols, disulfides, and total thiols were measured by a novel and automated assay. Disease severity of vitiligo was assessed with Vitiligo Area Scoring Index (VASI) score. The extent, stage, and spread of vitiligo of patients were evaluated according to the Vitiligo European Task Force (VETF) system.Results:The native and total thiol levels of vitiligo patients were higher than those of healthy control group (P≤0.001 and 0.001, respectively). The median VASI score of patients was 0.7 (0.02–28.30). Univariate analyses showed that plasma native thiol levels, VETF spread score, disease duration, and vitiligo type significantly correlated with VASI scores (r=0.237, P=0.043; r=0.458, P<0.001; and P<0.001, respectively). Stepwise multivariate analysis revealed that disease duration (β=0.017; P=0.005) and spread score (β=1.301; P=0.001) were found statistically significant as independent factors on VASI score.Conclusion:Although plasma native thiol level significantly correlated with VASI scores of patients, it is not a predictive factor for vitiligo severity.

A prospective study comparing the safety and efficacy of combination of topical tacrolimus 0.1% and mometasone furoate 0.01% with topical tacrolimus 0.1% alone in vitiligo

Background: Vitiligo is a common acquired skin disorder. Corticosteroids are considered to be the first line treatment for vitiligo, but have side effects on prolonged use. Calcineurin inhibitors like Tacrolimus are found to be effective which is used either alone or in combination with steroids. The advantage of combination therapy of Tacrolimus with Mometasone is that it provides additional benefit for the disease as well as the adverse effects of steroids can be minimised. The main objective of this study is to compare the safety and efficacy of combination of topical Tacrolimus 0.1% and Mometasone furoate 0.01% with topical Tacrolimus 0.1% alone in vitiligo.Methods: In this study 90 patients were divided into two groups to receive either combination treatment of topical Tacrolimus 0.1% and Mometasone furoate 0.01% or topical Tacrolimus 0.1% alone. The efficacy was measured in terms of mean improvement in VASI (Vitiligo Area Scoring Index) scores at 2weeks, 4weeks, 6weeks, 12weeks, and 24weeks from the start of therapy. Safety of the drugs were measured in terms of adverse effects reported during therapy.Results: At the start of the study, mean VASI scores of both groups were comparable. At the endpoint, mean VASI improvement score was statistically significant among the combination group (57.82vs31.45, p &lt;0.001). Adverse effects were found to be less in combined treatment group (p= 0.046).Conclusions: Combination treatment (Tacrolimus+ Mometasone) found to be superior to Tacrolimus alone in the treatment of vitiligo in terms of efficacy and safety.