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Predilection sites for skin signs of vitiligo disease activity determined

Presented by
Dr Liesbeth Delbaere , Ghent University Hospital, Belgium
SPIN 2022
The distribution of disease activity signs shows a discrepancy between segmental and non-segmental vitiligo. The new study also detected hotspots for the presence of different activity signs, such as the Koebner phenomenon and hypochromic areas.

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 confetti‐like 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]

  1. Van Geel N, et al. J Eur Acad Dermatol Venereol. 2019;33:1667-75.
  2. Delbaere L, et al. Hot spots of clinical signs of disease activity in vitiligo. P025, SPIN 2022 Congress, 06–08 July, Paris, France.
  3. Van Geel N, et al. Br J Dermatol. 2020;183:883-90.


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