https://doi.org/10.55788/f821a90c
As the course of depigmentation in vitiligo is difficult to foresee, the possibility of determining skin signs of activity may be helpful for disease management [1]. A study by Dr Liesbeth Delbaere and colleagues (Ghent University Hospital, Belgium) aimed to establish the prevalence of confettiālike depigmentation, the Koebner phenomenon, and hypochromic areas/borders [2]. An association to clinical activity was found for these signs that are included in the Vitiligo Signs of Activity Score (VSAS) [3].
The study included 503 vitiligo patients, of whom 446 had non-segmental and 57 had segmental disease [2]. At least 1 activity sign for vitiligo was found in 51% of patients with non-segmental disease, yet only in 9% of patients with the segmental form. Furthermore, in non-segmental vitiligo, all 3 activity signs were observed in around one-third to one-fourth of patients, while in segmental vitiligo, the Koebner response did not occur, and confetti-like depigmentation was rare.
Looking at 15 different body areas in those with non-segmental vitiligo, confetti-like depigmentation was present in around 40% on dorsal arms, feet, and ankles. The highest prevalence of the Koebner phenomenon was seen in around 30% on the back of hands and anterior legs. Hypochromic borders occurred most frequently on anterior arms and legs.
Based on the evaluation of 65 body locations, joints on posterior elbows/hands and anterior knees were similarly recognised as hotspots for confetti-like depigmentation and Koebner response (see Figure). In confetti-like depigmentation, the front ankle joint and, in the Koebner phenomenon, the front elbow and shoulders were also included. Hotspots for hypochromic areas were different and less concise: whole back, posterior legs, elbows, and axilla. The investigators expressed that knowing where the hotspots are will help to improve and simplify clinical detection of signs.
Figure: Hotspots for clinical activity signs [2]
- Van Geel N, et al. J Eur Acad Dermatol Venereol. 2019;33:1667-75.
- Delbaere L, et al. Hot spots of clinical signs of disease activity in vitiligo. P025, SPIN 2022 Congress, 06ā08 July, Paris, France.
- Van Geel N, et al. Br J Dermatol. 2020;183:883-90.
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