Vitiligo Area Research Articles

A pilot study of combined oral minocycline and narrowband UVB phototherapy in vitiligo: A randomized, double-blind, placebo-controlled trial.

Narrowband ultraviolet B (NBUVB) phototherapy is an effective therapeutic option for generalized vitiligo. Previous reports showed the potential benefit of minocycline to stop disease progression in vitiligo. Meanwhile, minocycline has antioxidative, anti-inflammatory, and immunomodulating properties. There is no clinical study combining oral minocycline and NBUVB for treating generalized vitiligo. This study aims to compare the efficacy and safety of the combination treatment of NBUVB plus oral minocycline with NBUVB alone in generalized vitiligo. A randomized, double-blinded, placebo-controlled pilot study was conducted. Patients were randomly treated with either combined oral minocycline 100 mg per day plus NBUVB phototherapy or placebo plus NBUVB. All patients recieved NBUVB two times per week, for 12 weeks. The outcomes were assessed using Vitiligo Area Scoring Index score (VASI) percent change, quartile grading scale (QGS) of repigmentation, and Vitiligo Disease Activity Index (VIDA) score. Fourteen generalized vitiligo patients were included, and seven cases were assigned in each group. At week 12, the mean VASI score was decreased by 28.87% (24.15) in the minocycline group compared to 27.26% (7.98) in placebo group (p= 0.886). No significant difference was observed between both treatment modalities in QGS of repigmentation and mean VIDA score change. Two of the seven patients (29%) receiving minocycline developed hyperpigmentation, dark-brown and muddy brown discoloration, which was only confined to some vitiliginous patches. In conclusion, combination therapy with oral minocycline does not enhance the efficacy of NBUVB in generalized vitiligo. Due to the high incidence of drug-induced skin hyperpigmentation, minocycline plus NBUVB should be avoided.

Combination of acitretin and narrowband UV-B for the treatment of vitiligo: A new treatment modality with an impact on tissue E-cadherin expression

Combination of acitretin and narrowband UV-B for the treatment of vitiligo: A new treatment modality with an impact on tissue E-cadherin expression

Post-Traumatic Stress in Vitiligo Patients: A Neglected but Real-Existing Psychological Impairment.

BackgroundVitiligo is the most common depigmentation disorder. This disease causes disfiguration and induces psychological burdens, leading to significantly impaired quality of life. Limited research about disease-related post-traumatic stress (PTS) has been conducted in vitiligo patients.ObjectiveTo evaluate the prevalence, severity, and risk factors of post-traumatic stress in vitiligo patients.MethodsThis case-control study was performed from January 2021 to April 2021. A survey questionnaire including baseline information, post-traumatic stress symptoms evaluation, life quality evaluation was conducted. According to the severity of post-traumatic stress symptoms, patients were grouped and compared. The logistic regression model was conducted to analyze the risk factors for post-traumatic stress disorder (PTSD).ResultsA total of 337 patients were included. A 30.3% of vitiligo patients (102/337) in present cohort had PTS and 12.5% patients (42/337) were confirmed for developing into PTSD. The multivariate logistic regression revealed educational level<university (OR=2.32, 95% CI=1.97–2.93, P=0.003), vitiligo in face and neck (OR=2.65, 95% CI=2.08–3.12, P=0.008), vitiligo in feet and hands (OR=1.86, 95% CI=1.54–2.12, P<0.001) and surgical treatment (OR=3.53, 95% CI=3.12–4.02, P<0.001) were risk factors for PTSD. PTS severity was significantly associated with vitiligo disease activity score (rho=0.54, R2=0.29, P=0.002), vitiligo area scoring index score (r=0.55, R2=0.30, P=0.012), and dermatology life quality index score (r=0.61, R2=0.37, P=0.004).ConclusionVitiligo-related PTS is prevalent in vitiligo patients and causes psychological impairment. Dermatologists should realize and identify this condition carefully and offer proactive intervention to improve patients’ quality of life.

Metabolomics Signature and Potential Application of Serum Polyunsaturated Fatty Acids Metabolism in Patients With Vitiligo.

Vitiligo is a depigmented skin disorder caused by a variety of factors, including autoimmune, metabolic disturbance or their combined effect, etc. Non-targeted metabolomic analyses have denoted that dysregulated fatty acids metabolic pathways are involved in the pathogenesis of vitiligo. However, the exact category of fatty acids that participate in vitiligo development and how they functionally affect CD8+ T cells remain undefined. We aimed to determine the difference in specific fatty acids among vitiligo patients and healthy individuals and to investigate their association with clinical features in patients with vitiligo. Serum levels of fatty acids in 48 vitiligo patients and 28 healthy individuals were quantified by performing ultra-performance liquid chromatography-tandem mass spectrometry. Univariate and multivariate analyses were carried out to evaluate the significance of differences. Moreover, flow cytometry was used to explore the effect of indicated fatty acids on the function of CD8+ T cells derived from patients with vitiligo. We demonstrated that serological level of alpha-linolenic acid (ALA) was markedly upregulated, while that of arachidonic acid (ARA), arachidic acid (AA) and behenic acid were significantly downregulated in patients with vitiligo. Moreover, ALA levels were positively associated with vitiligo area scoring index (VASI) and ARA was a probable biomarker for vitiligo. We also revealed that supplementation with ARA or nordihydroguaiaretic acid (NDGA) could suppress the function of CD8+ T cells. Our results showed that vitiligo serum has disorder-specific phenotype profiles of fatty acids described by dysregulated metabolism of polyunsaturated fatty acids. Supplementation with ARA or NDGA might promote vitiligo treatment. These findings provide novel insights into vitiligo pathogenesis that might add to therapeutic options.

A comparative study of suction blister epidermal grafting and automated blister epidermal micrograft in stable vitiligo

The automated blister epidermal micrograft (ABEM) is a newly introduced surgical transplantation for refractory vitiligo. Comparative analysis of other surgical methods is lacking. We conducted a retrospective study to compare the efficacy, safety, and experience of ABEM with conventional suction blister epidermal graft (SBEG). A total of 118 anatomically based vitiligo lesions from 75 patients were included. The primary outcome was the degree of repigmentation; the patient and operator experience were evaluated. SBEG had a significantly greater incidence of repigmentation (p < 0.001), as measured by the Physician Global Assessment, as well as improvements in the Vitiligo Area Scoring Index, particularly on the face/neck area (p < 0.001). ABEM, on the contrary, had reduced donor harvest time, a better patient operative experience, and more significant Dermatology Life Quality Index improvements. In a subgroup of 38 lesions from ten patients who received both SBEG and ABEM concomitantly, there was no difference in the degree of repigmentation in the same recipient area. Overall, the degree of repigmentation for SBEG is higher than ABEM, especially in the mobilized region, and the cost is less expensive. On the contrary, ABEM requires less procedure learning curve and can supply a greater transplanting zone with shorter donor site recovery. Understanding the benefits and drawbacks of two blister grafting procedures is essential for optimal surgical outcomes for vitiligo grafting.

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.

A comparative study of efficacy and safety of topical 10% phenylalanine gel versus 0.1% mometasone furoate cream in limited nonsegmental vitiligo

Background: Among various therapeutic options for treating vitiligo, the search for an effective agent to minimize disease progression and achieve repigmentation continues. Topical phenylalanine 10% gel has shown promising results, and hence this study was carried out in patients with limited vitiligo. Aim: To compare the efficacy and safety of topical 10% phenylalanine gel versus topical 0.1% mometasone furoate cream in patients with limited nonsegmental vitiligo. Materials and methods: This study included 74 participants diagnosed as limited nonsegmental vitiligo (≤5 skin lesions). Group A received topical 10% phenylalanine gel (twice daily application), whereas Group B received topical 0.1% mometasone furoate cream (once daily application) for a period of 16 weeks. Clinical improvement based on vitiligo area severity index (VASI) scoring was assessed at intervals of 4 weeks until the end of the study duration. Physician’s global improvement assessment was calculated at the end of the study based on VASI scores. Results: Group A participants showed improvement of 24% when compared with 30.7% in group B at end of 16 weeks. Reduction in VASI scores and clinically visible improvement were noted in both groups after 8 weeks. Adverse events were not noted in any of the groups. Lesions over hands and feet were 11.3 times less likely to show response to treatment when compared with other sites. Conclusion: Both phenylalanine and mometasone were able to achieve significant repigmentation in the participants without any adverse effects. Mometasone achieved marked to excellent response in a higher percentage of participants. The overall efficacy of topical mometasone cream was better than topical phenylalanine gel.

A case control study on the role of interleukin 17 in the pathogenesis of vitiligo

Background: Interleukin 17 (IL-17) has recently been implicated in the pathogenesis of vitiligo by many studies but it is unclear whether it has any definitive role in causing depigmentation. IL-17 inhibitors have already been used in other inflammatory disorders with good results and may prove to be a valuable therapeutic modality in vitiligo. Thus, this study aims at adding to the existing data on the role of IL-17 in the pathogenesis of vitiligo. Objectives: (1) To determine the correlation between IL-17 and the extent of body surface area involvement. (2) To determine the correlation between IL-17 and the severity of disease activity. (3) To determine the correlation between IL-17 and serum vitamin D levels. Methodology: Thirty-two clinically diagnosed patients with vitiligo and 26 age- and sex-matched controls who fulfill the inclusion criteria were enrolled in the study. After obtaining a detailed history, a complete dermatologic examination was performed and vitiligo area severity index (VASI) and vitiligo disease activity score (VIDA) were assigned. The baseline serum IL-17 level was measured using Raybiotech serum IL-17 enzyme-linked immunosorbent assay kit. Serum vitamin D was measured for all cases and controls. Results: In our study, the mean VASI score of all the patients was 6.32 ± 10.14 and the mean VIDA score was 1.97 ± 0.999. The mean serum IL-17 levels were 155.72 ± 79.412 pg/mL in patients with vitiligo compared to 102.73 ± 56.478 pg/mL of the controls, with a mean difference of 52.99 pg/mL and the difference was statistically significant (P = 0.008). Although, there is no significant correlation between the serum IL-17 levels with the VASI score, our study noticed slightly higher levels of IL-17 in generalized vitiligo and lowest levels were noticed in localized vitiligo. Limitations: Our study was limited by the small sample size of 32. Conclusion: Although, serum IL-17 levels were significantly higher in the patient group than the controls, there was no correlation with the disease extent or activity. Thus, it is difficult to establish a causal role of serum IL-17 in vitiligo.

Individualized Homeopathic Medicines in Treatment of Vitiligo: Double-Blind, Randomized, Placebo-Controlled Pilot Trial.

Objective: The feasibility of a definitive trial was tested to evaluate individualized homeopathic medicines (IHMs) for the treatment of vitiligo. Design: This was a double-blind randomized (1:1) placebo-controlled pilot trial conducted at the National Institute Homeopathy, India. Sixty patients with vitiligo were included in the study. Interventions: IHMs and identical-looking placebos at 50-millesimal (LM) potencies. Outcome measures: Feasibility issues and scores from the Vitiligo Area Scoring Index (VASI), Vitiligo-specific Quality-of-life instrument (VitiQoL), and Dermatology Life Quality Index (DLQI) were measured at baseline and after 3 and 6 months. Results: The recruitment and retention rates were satisfactory. Mean reductions in the outcome measures were higher in the IHM group than placebo. Conclusions: Definitive efficacy trials are warranted. Clinical Trials Registry-India: CTRI/2018/10/016160; secondary identifier UTN: U1111-1221-7704.

Assessment of CXCL10 Before and After Narrow Band UVB Phototherapy in Non-Segmental Vitiligo Patients.

Vitiligo is a common depigmenting skin disorder characterized by white macules and patches accompanied by local melanocyte loss, caused by autoimmune destruction. Vitiligo is classified into two major forms: segmental vitiligo (SV) and non-segmental vitiligo (NSV). It was also found that the IFN-ȣ/CXCL10 axis is functionally required for both progression and maintenance of the disease. Chemokine 10 (CXCL10) is a pro-inflammatory chemokine which was found to be elevated in the serum of vitiligo patients. UVB has been found to be a useful therapy that results in rapid repigmentation in NSV patients. To evaluate CXCL10 in vitiligo patients before and after narrow band UVB (NB-UVB) phototherapy, which if targeted could provide new insights for therapeutic intervention for vitiligo. The study included 25 active NSV patients who were able to comply with the study protocol in the Center of Excellence, Dermatology Outpatient Clinic, National Research Center, Egypt (February 2020-2021). All recruited patients were subjected to documentation of complete history. Dermatological assessment of vitiligo lesions, including vitiligo area score index (VASI) score, CXCL10 and extent of the disease were performed. A 3 mm punch biopsy from active vitiligo lesion (site of biopsy) was taken before and after treatment by NB-UVB, and then immunohistochemical staining was performed to evaluate expression of CXCL10. After treatment by NB-UVB there was a significant decrease in VASI score, extent of the disease and CXCL10 expression. The decrease in CXCL10 levels could be attributed to the effect of NB-UVB which leads to decrease in IFN-γ level, necessary to release CXCL10 through its pathway resulting in repigmentation and decrease in the extent of the disease and VASI scores.

Clinical Significance of Serum Oxidative Stress Markers to Assess Disease Activity and Severity in Patients With Non-Segmental Vitiligo

Non-segmental vitiligo (NSV) is a chronic autoimmune disease characterized by progressive depigmentation of the skin. Oxidative stress (OS) has been proposed as one among the main principal causes in the development and establishment of a sustained autoimmune state in patients with NSV. However, the disease-associated OS biomarkers in clinical practice are not well studied. In this study, we found significantly reduced antioxidant enzymes [catalase (CAT) and superoxide dismutase (SOD)], total antioxidant capacity (TAC), and increased levels of lipid oxidation product malondialdehyde (MDA) and oxidative DNA damage byproduct [8-hydroxy-2-deoxyguanosine (8-OHdG)] in serum of NSV patients compared with healthy controls (HC). Serum TAC, MDA, and 8-OHdG levels were correlated with disease activity in all patients with NSV and much lower in patients receiving conventional treatment in the past 1 year compared to that without treatment. In addition, both serum MDA and 8-OHdG levels were significantly correlated with CXCL10 expression in patients with NSV. And the serum TAC, MDA, and 8-OHdG levels were also correlated with affected body surface area and Vitiligo Area Scoring Index score in patients with NSV. This study demonstrates dysregulated OS status in patients with NSV and provides the evidence that the serum TAC, MDA, and 8-OHdG have a capacity to indicate the activity and severity in patients with NSV.

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.

303 Maintenance of Repigmentation After Discontinuation of Ruxolitinib Cream in Patients With Vitiligo

Treatment with ruxolitinib cream (Janus kinase [JAK] 1/JAK2 inhibitor) in adult patients with vitiligo resulted in substantial repigmentation over 52 weeks in a phase 2 dose-ranging study (NCT03099304). We assessed maintenance of repigmentation among responders from the phase 2 study following ruxolitinib discontinuation after 104 weeks of treatment. Patients initially randomized to ruxolitinib cream (1.5% twice daily [BID], 1.5% once daily [QD], 0.5% QD, or 0.15% QD) with evidence of facial repigmentation at Week 24 who completed ≥1 follow-up visit 1, 3, or 6 months after an additional 52 weeks of 1.5% ruxolitinib cream BID (Weeks 52–104) were analyzed. Loss of repigmentation was defined as an increase in Vitiligo Area Severity Index score during the last follow-up visit vs Week 104 on ruxolitinib cream. The analysis included 16 patients (1.5% BID, n=3; 1.5% QD, n=5; 0.5% QD, n=3; 0.15% QD, n=5 [including 2 patients rerandomized to 1.5% BID/0.5% QD after Week 24]). Twelve patients (75.0%) maintained total body repigmentation and 13 (81.3%) maintained facial repigmentation during follow-up of 1–6 months; no patients from the 1.5% ruxolitinib BID treatment group (with 2 years’ exposure) experienced repigmentation loss. There were no significant differences in baseline serum levels of chemokine (C-X-C motif) ligand (CXCL) 9, CXCL10, or interleukin-15 in patients who experienced loss vs maintenance of repigmentation after ruxolitinib cream discontinuation. This exploratory analysis suggests that some repigmentation with ruxolitinib cream may be maintained post-discontinuation; larger follow-up studies are required to confirm these findings.

27636 Addition of narrow-band ultraviolet light B phototherapy to ruxolitinib cream in patients with vitiligo

Previous reports with Janus kinase (JAK) inhibitors have suggested additional therapeutic benefit with concomitant phototherapy in patients with vitiligo. In a phase 2, randomized, dose-ranging study in adult patients with vitiligo (NCT03099304), ruxolitinib cream, a JAK1/JAK2 inhibitor, was associated with substantial repigmentation for up to 52 weeks of treatment as assessed by ≥50% improvement in facial and total Vitiligo Area Scoring Index (F-VASI50 and T-VASI50). After Week 52, patients were allowed to add narrow-band ultraviolet-B (NB-UVB) therapy while continuing open-label treatment with twice-daily 1.5% ruxolitinib cream.

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.

English

BACKGROUND Vitiligo is a hypopigmentary disease of the skin which is associated with impaired quality of life and depression. In our present study, we evaluated the serum levels of homocysteine, vitamin B12, and folic acid in patients with vitiligo and controls in a tertiary care centre and also their association with the extent and activity of vitiligo. METHODS An analytical cross-sectional study was conducted on 40 patients with vitiligo and 40 controls visiting a tertiary care centre for a period of one year. Detailed history regarding demographic data, history of disease, family history, duration of the disease etc. was recorded. Vitiligo Disease Activity Score (VIDA SCORE) and vitiligo area scoring index (VASI) of each body region was calculated. After explaining the procedure, fasting (5 ml) blood sample was drawn and the levels of homocysteine, vitamin B12, and folic acid were measured. Data was analysed using SPSS software and P value less than 0.05 was considered statistically significant. RESULTS There was statistical significance between vitiligo patients and controls of serum vitamin B12, homocysteine and folic acid (P &lt; 0.05) and there was significant association for males in cases and controls (P &lt; 0.05). CONCLUSIONS Vitiligo is associated with elevated levels of serum homocysteine and decreased levels of vitamin B12 and folic acid. KEY WORDS Vitiligo, Homocysteine, Vitamin B12, Folic Acid, Depigmentation

Development and validation of the fingertip unit for assessing Facial Vitiligo Area Scoring Index

Facial involvement of vitiligo is an important factor in a patient's life and has often been evaluated separately from body surface area in clinical trials. However, no reliable tools to measure facial vitiligo specifically are available thus far. To develop and validate a practical instrument for assessing facial vitiligo. The ratios of a hand to a fingertip unit (FTU) of 98 healthy volunteers (age range, 2-69years) were calculated to define the FTU. Facial Vitiligo Area Scoring Index was measured as the sum of all FTUs of each vitiligo lesion on the face (range, 0-112 FTU). In the validation study, 6 raters evaluated 11 patients with facial vitiligo twice at an interval of 2weeks. One hand was measured at 32.1±1.3 FTU, which was highly consistent among subjects across different age groups, sexes, and races. Facial Vitiligo Area Scoring Index showed remarkably high accuracy (concordance correlation coefficient, 0.946; smallest detectable change, 2.2 FTU) as well as high intrarater reliability (intraclass correlation coefficient, 0.903; inter-rater reliability, 0.903). Lack of dynamic validation of responsiveness. Facial Vitiligo Area Scoring Index using the FTU is an intuitive, precise, and reliable instrument for assessing the extent of facial involvement in vitiligo patients.

Reliability, Validity and Feasibility of the Vitiligo Extent Score (VES) and Self-Assessment Vitiligo Extent Score (SA-VES) Among Vitiligo Patients: A Cross-Cultural Validation.

BackgroundThe Vitiligo Extent Score (VES) and Self-Assessment Vitiligo Extent Score (SA-VES) have not been formally validated in Thai population.ObjectiveTo evaluate reliability, validity and feasibility of the VES and SA-VES in Thai vitiligo patients.MethodsVitiligo lesions from 100 patients were evaluated by 2 independent dermatologists using VES and Vitiligo Area Scoring Index (VASI). Reliability was assessed by comparing VES scores between physicians. Validity was determined by comparison among the VES, VASI, and SA-VES instruments. Patients scored their vitiligo severity using the SA-VES.ResultsThe reliability of the VES was excellent (inter-rater reliability: 0.997, 95% confidence interval: 0.995–0.998). There was very strong correlation between the VES and VASI (r=0.976, p<0.001), and strong correlation between the VES and SA-VES (r=0.890, p<0.001), and between the VASI and SA-VES (r=0.866, p<0.001). Moderate correlation among the VES, VASI, and SA-VES was observed in patients with segmental or <1% body surface area (BSA) vitiligo. Ninety-five percent of patients rated the SA-VES as easy to moderately easy.ConclusionThe VES has reliability and validity comparable to that of the VASI. The SA-VES is an user-friendly instrument that correlated well with physicians’ scoring methods in patients with non-segmental or >1% BSA vitiligo.

Granzyme B gene polymorphism in vitiligo: does it have an association?

Objectives To study the role of granzyme B (GZMB) gene polymorphism (rs8192917) in patients with nonsegmental vitiligo and to correlate the results with the available clinical information. Background Vitiligo is considered the most common acquired disease of depigmented skin characterized by depigmented patches of the skin, hair, and mucous membranes owing to destruction of melanocytes. Vitiligo is a multifactorial polygenic condition with a multifaceted pathogenesis, linked to both genetic and nongenetic aspects, such as autoimmune, cytotoxic, oxidant–antioxidant, and neural therories working in performance. Patients and methods GZMB gene polymorphism (rs8192917) was identified using real-time PCR technique in 40 patients having nonsegmental vitiligo and 40 age-matched and sex-matched healthy controls. Assessment of disease severity was done using Vitiligo Area Severity Index score, and disease activity was assessed using Vitiligo Disease Activity score. Results CC and TC genotypes were significantly higher in the patients' group [P = 0.005; odds ratio (OR) = 7.2, 95% confidence interval (CI) = 1.61–32.2 for CC and OR = 1.86, 95% CI = 0.42–8.15 for TC], with significant statistical preponderance of C allele in cases (P = 0.001; OR = 3.05, 95% CI = 1.55–6.01). Conclusion GZMB gene polymorphism (rs8192917) is associated with the susceptibility to nonsegmental vitiligo in a sample of Egyptian population.