Serial Assessment of Vitiligo Patches Results in Early Recognition

Investigators write that methods such as dermatoscopy can result in early recognition of unstable patches and lead to appropriate medical treatment for patients with vitiligo.

Research from the Postgraduate Institute of Medical Education and Research in India found that serial assessment of vitiligo patches on patients post-non-cultured epidermal cell suspension (NCES) resulted in early recognition of unstable patches.

Additionally, the appearance of normal pigment network at 8 weeks by dermatoscopy was a predictor of excellent repigmentation.

The study, led by Keshavamurthy Vinay, MD, DNB, asserted the role of dermatoscopy in assessing disease stability and predicting repigmentation rates in vitiligo patients undergoing NCES.

Stability in vitiligo was considered a dynamic process by the investigators, with lesion stability of at least 12 months being essential for treatment success in patients undergoing autologous NCES.

However, surgically treated vitiligo patches could develop instability anytime during follow-up, which could adversely affect repigmentation rates and pigment retention.

In their study, Vinay and colleagues evaluated the role of serial dermatoscopic monitoring in assessing disease stability and predicting repigmentation rates in vitiligo patients undergoing NCES.

The Study

Participants in the study were recruited from the patients who attended the pigmentary and dermatosurgery clinic of department of Dermatology, Venereology and Lueprology, Postgraduate Institute of Medical Education and Research in Chandigarh, India.

The team performed NCES on 2 patches each for 26 patients of vitiligo, which totaled 56 patches that were all clinically stable for at least 1 year (VIDA 0)

Repigmentation was assessed at follow-up visits with clinical and photographic assessments.

Successful repigmentation was defined as repigmentation greater than 75% and excellent repigmentation as greater than 90%.

The investigators performed dermatoscopic assessments of target lesions at baseline and post-procedure at weeks 4, 8, 12, 16 and 24.

The images were later archived.

The dermatoscopic features of target lesions that showed clinical signs of disease activity anytime during the follow-up period were compared to those who maintained clinical stability throughout.

A Fischer exact test was done to explore the difference in the dermoscopic parameters between the 2 groups.

All 26 patients (17 females, 9 males) completed the study and were included in the final analysis.

The Findings

Vinay and investigators found that 19 (73%) participants had a VIDA of -1 at baseline and 7 (27%) had a VIDA of 0 at baseline.

Additionally, 18 patients (69.2%) had non-segmental vitiligo and 8 patients (30.8%) had segmental type of vitiligo. Baseline dermatoscopic features included absent pigment network (96%) and sharp margins (100%) suggestive of stable vitiligo.

In a follow-up, investigators recorded 6 patches that showed signs of instabililty, with 2 of them showing focal loss of pigmentation after initial repigmentation following NCES and 1 with complete loss of pigment.

By 24 weeks, 2 of the patches (33.33%) showed focal loss of pigment network while a single patch completely depigmented. Normal pigment network at 24 weeks was seen in only 3 (50%) patches in the unstable group, whereas 37 (80%) patches in the stable group showed normal reticular pigment network.

Excellent repigmentation (>90%) was achieved in 29 out of 52 patches, and it was noted that appearance of normal reticular pigment network at 8 weeks was a positive predictor of excellent response (OR=10.5, confidence intervals 1.2 – 89.7).

Overall, the study proved the effectiveness of routine patch assessment via dermatoscopy and similar methods.

“Serial assessment of the vitiligo patches post NCES for dermoscopic markers of instability can help in early recognition of unstable patches and initiation of appropriate medical treatment (including topical corticosteroids and tacrolimus) or targeted phototherapy to retain stability and augment repigmentation,” the team wrote.

The study, “Dermoscopic assessment of treatment response in patients undergoing autologous non cultured epidermal cell suspension for the treatment of stable vitiligo: a prospective study,” was published online in Dermatologic Therapy.