Vitiligo Extent Score Research Articles

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.

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.

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.

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.

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.

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.

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.

Clinical and pathogenetic justification of the use of methotrexate in the treatment of progressive non-segmental vitiligo

BACKGROUND: Vitiligo is an urgent problem both for patients and for the scientific community of dermatologists. There are many studies aimed at finding new methods of therapy for this disease, but there are no effective schemes for repigmentation of foci and stabilization of the process in modern dermatology. In this regard, the search for means that have a pathogenetic effect is relevant.&#x0D; AIMS: Clinical and laboratory evaluation of the effectiveness of methotrexate in vitiligo.&#x0D; MATERIALS AND METHODS: Preliminary results of a study of the effectiveness of methotrexate in the treatment of vitiligo are presented. Clinical effects were assessed using the VES index (Vitiligo extent score). The dynamics of immunological parameters and the influence of vitiligo on the quality of life were also determined.&#x0D; The study included 77 patients suffering from non-segmental vitiligo. All the subjects were divided into 2 groups. Patients of group 1 (39 patients) received methotrexate in combination with phototherapy, patients of group 2 (38 patients) underwent a course of UVB-311nm. The area of depigmentation was determined, and after treatment repigmentation, relative to the surface area of the body. The dynamics of the immune status against the background of therapy was analyzed. The correlation of the prevalence of the process with the quality of life was evaluated. The duration of the study was 4 months.&#x0D; RESULTS: There were no statistically significant differences in clinical and laboratory parameters among the groups before treatment. Patients included in group 1 and receiving combination therapy with methotrexate and medium-wave narrow-band therapy with UVB-311nm demonstrated more active repigmentation of vitiligo foci than the studied 2 groups. Also, patients of this group demonstrated the most active positive dynamics of the dermatological quality of life index, correlating with the prevalence of the process. Analysis of the dynamics of immune status indicators allowed us to conclude that the best tendency to normalize cytokine levels among group 1 patients.&#x0D; CONCLUSIONS: Our study demonstrated the clinical and pathogenetic efficacy of methotrexate. Small doses of the drug are well tolerated, which allows a long-term effect on pathogenetic mechanisms, stabilizing the skin process.

Efficacy and safety of combined fractional ablative CO2 laser and 5 fluorouracil in the treatment of acral vitiligo: An open, uncontrolled study.

Acral lesions of vitiligo are most likely recalcitrant to the known lines of treatment. Ablative fractional CO2 has shown efficacy in treatment of vitiligo in combination with other modalities. Thirty non-segmental vitiligo patients with acral lesion were included in the study. Each patient was subjected to fractional Carbon Dioxide Laser Treatment followed by application of 5 fluorouracil (5FU) cream for five consecutive days. Evaluation was done 3 weeks from the start of treatment and 12 weeks after the last treatment session using VESTA score, evaluation of patients' photos by blinded investigation in addition to patients' satisfaction scores. Patients showed significant improvement of Vitiligo extent score for a target area (VESTA) score and developed considerable degree of repigmentation as assessed by blinded investigators. The combination of fractional ablative CO2 and 5FU is an effective and safe procedure for the treatment of acral vitiligo with promising results offering patients a new therapeutic window.

Comparative study of the effectiveness of combination therapy of vitiligo with methotrexate in combination with medium-wave narrow-band therapy UVB-311 nm and monotherapy UVB-311 nm

BACKGROUND: Vitiligo, a multifactorial chronic acquired disease with a genetic predisposition, occurs due to the destruction of melanocytes of the skin and is characterized by the appearance of foci of depigmentation. Despite the fact that new therapies are emerging, there are no actual treatment regimens that would guarantee a positive result, including stopping the progression of the process, repigmentation. In this regard, it is advisable to search for drugs that have an immunosuppressive effect.&#x0D; AIMS: Clinical evaluation of the effectiveness of methotrexate in combination with UVB-311 nm and UVB-311 nm monotherapy in vitiligo.&#x0D; MATERIALS AND METHODS: 77 patients suffering from progressive vitiligo were included in this study. All patients were divided into 2 groups. A course of methotrexate therapy in combination with UV therapy was prescribed to 39 patients, UVB-311 nm monotherapy was performed in 38 patients. The lesion area relative to the body surface area was estimated using the VES index (Vitiligo extent score) on the vitiligo calculator. The effect of the disease on the quality of life was assessed using the Dermatology Life Quality Index (DLQI). The duration of the study was 6 months.&#x0D; RESULTS: The patients included in the study were divided into two groups randomly. There were 39 patients in group I, 38 in group II. 76 out of 77 patients completed it: 1 patient was excluded due to increased hepatic transaminases during methotrexate therapy. Among patients receiving combination therapy with methotrexate in combination with medium-wave narrow-band therapy UVB-311 nm, there was a more pronounced decrease in the percentage of depigmentation relative to the body surface area. And also patients of this group demonstrated the most active positive dynamics of the Dermatology Life Quality Index than patients who received only phototherapy.&#x0D; CONCLUSIONS: The study demonstrated good clinical efficacy of the drug. Small doses of methotrexate have a positive effect on the tolerability of the drug and prevent the development of side effects, which makes it possible to influence pathogenetic mechanisms for a long time, stabilizing the skin process.

Study of serum level of S100B as a biomarker of vitiligo activity

BackgroundVitiligo is a common acquired depigmenting skin disorder. Current pathophysiologic insights promote the theory that melanocytes are destroyed by the immune system, leaving persistent areas of depigmentation, other theories have been suggested regarding the causes for depigmentation, including deficient adhesion proteins, an increased presence of oxidative stress, and neurogenic factors.ObjectiveThe study aims to evaluate the serum level of S100B in vitiligo patients and its correlation with disease activity in comparison with healthy controls.Patients and methodsThis is a case–control study that included 60 patients with vitiligo who were diagnosed with clinical evaluation and 30 healthy individuals as a control group. All patients were assessed for activity by Vitiligo Disease Activity Score (VIDA score) last year and the authors used Vitiligo Extent Score (VES), which is estimated body mass index % and measured serum level of S100B by the enzyme-linked immunosorbent assay system.ResultsThere was a significant increase in the serum level of S100Bng/l in the patient group compared with the control (P value < 0.001) and a significant positive correlation between serum level of S100Bng/l and VIDA in the patient group.ConclusionSerum levels of S100B in vitiligo were used as a biomarker for activity.

Erratum: Validity and feasibility of the self-assessment vitiligo extent score among Egyptian patients.

Erratum: Validity and feasibility of the self-assessment vitiligo extent score among Egyptian patients.

Interleukin 38 serum level is increased in patients with vitiligo, correlated with disease severity, and associated with signs of disease activity.

Vitiligo is an acquired cutaneous depigmenting disease caused by a T helper (Th) 1-cytotoxic T cells driven autoimmune attack against melanocytes, in which Th17 is also involved. Interleukin (IL)-38 belongs to the IL-1 family of cytokines and suppresses Th1 and Th17 activation. IL-38 protein and mRNA levels have been found to be elevated in various autoimmune disorders and correlated with disease severity and activity, including psoriasis, systemic sclerosis, rheumatoid arthritis, and atopic dermatitis. No previous studies have been performed to investigate the expression of IL-38 in patients with vitiligo. To evaluate IL-38serum level in patients with vitiligo compared to healthy controls (Hcs) and examine the association between IL-38level and severity and activity of vitiligo. The study comprised 21 patients with vitiligo and 21 Hcs. Vitiligo severity and activity were evaluated via Vitiligo Extent Score (VES) and Vitiligo Disease Activity (VIDA) Score, respectively. IL-38serum level was evaluated by enzyme-linked immunosorbent assay. Vitiligo patients had significantly higher serum level of IL-38 than Hcs (p<0.001). This level was significantly higher among patients with signs of vitiligo activity (p=0.048), correlated positively with VES (p<0.001), and correlated negatively with the age of patients (p=0.001) and the age of disease onset (p=0.022). IL-38serum level was higher in patients with vitiligo than in Hcs and was related to vitiligo severity and signs of activity.

Pilot Study on the Use of the "Monocyte-Rich" Platelet-Rich Plasma in Combination with 1927 nm Fractional and 308 nm Excimer Lasers for the Treatment of Vitiligo.

Background and objectives: Vitiligo is an acquired chronic and idiopathic skin disorder, characterized by selective loss of melanocytes and resulting in a cutaneous depigmentation. Treatment for vitiligo remains a challenge for dermatologists; thus, it is frustrating both for physicians and patients. The objective of this study was to evaluate a combination treatment characterized by the use of a leukocyte-rich platelet-rich plasma, which is particularly rich in monocytes (defined here as monocyte-rich PRP), in combination with a 1927 nm fraxel laser and a 308 nm excimer laser. Materials and Methods: Treatment with monocyte-rich PRP combined with 1927 nm fraxel laser and 308 nm excimer laser was performed in nine sessions in 80 days and the median follow-up of the patients was 10 months. A total of 27 Caucasian patients were included in the present study. The median age of patients was 41 years, ranging between 20 and 69 years. Results: A re-pigmentation occurred in 16 cases (59%) with a reduction of the Vitiligo Extent Score (VES) and absence of re-pigmentation in untreated areas. Performing a rank correlation between VES and re-pigmentation in the treated areas, we found that there was a significant correlation (p < 0.0001). The presence of progressive vitiligo (p = 0.1) and the anatomic areas (p = 0.1) did not influence the treatment. Untreated areas did not show any improvement of the depigmented lesions, except in one case (p < 0.0001). Conclusions: in this report, we show for the first time how PRP rich in monocytes, in combination with laser therapies, gives a long therapeutic response, which persists even after 10 months of follow-up.

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.