Depigmentation Patterns of Nonsegmental Vitiligo
Tóm tắt
Efforts have been recently made to investigate simple, objective, accurate, and reproducible methods of clinical/noninvasive assessment of nonsegmental vitiligo. However, studies have mostly considered quantitative or semiquantitative parameters, almost neglecting the purely qualitative appearance of vitiligo lesions at a given moment and over time. The objective of this study was to investigate the dynamics of macromorphologic alterations taking place within vitiligo patches. This was a prospective study of a vitiligo cohort. Consecutive patients affected by nonsegmental vitiligo. Enrolled patients affected by nonsegmental vitiligo underwent a dermatology visit once monthly for 12 months. Vitiligo lesions were photographed at each visit under both room light and Wood’s light, and analyzed via a morphometric, digitalized software capable of detecting quantitative changes of white areas. Pictures depicting changing patches were evaluated in order to assess clinical morphology. Ninety patients were included for the final analysis and 360 lesions were evaluated, 102 of which (28.9 %) showed changes of white areas. Subjective evaluation highlighted two distinct depigmentation patterns, which were present either alone or in combination: (1) a sharply defined band of intermediate color between the depigmented center and the surrounding normal skin, which was defined as ‘marginal hypopigmentation;’ and (2) pinpoint hypopigmented/depigmented macules centered by a follicle, which we named ‘perifollicular depigmentation.’ On the other hand, only one repigmentation pattern was detected, the already known ‘perifollicular repigmentation.’ The depigmentation process in vitiligo seems to follow only two specific patterns. This preliminary study represents, in our opinion, a valuable background for future research aiming to investigate the dynamics of vitiligo pathogenesis or assess depigmentation/repigmentation patterns for monitoring treatment response.
Tài liệu tham khảo
Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: a comprehensive overview. Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. J Am Acad Dermatol. 2011;65:473–91.
Taïeb A, VETF Members. The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. Pigment Cell Res. 2007;20:27–35.
Sehgal VN, Srivastava G. Vitiligo: compendium of clinico-epidemiological features. Indian J Dermatol Venereol Leprol. 2007;73:149–56.
Felsten LM, Alikhan A, Petronic-Rosic V. Vitiligo: a comprehensive overview. Part II: treatment options and approach to treatment. J Am Acad Dermatol. 2011;65:493–514.
Hamzavi I, Jain H, McLean D, et al. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: the Vitiligo Area Scoring Index. Arch Dermatol. 2004;140:677–83.
Aydin F, Senturk N, Sahin B, et al. A practical method for the estimation of vitiligo surface area: a comparison between the point counting and digital planimetry techniques. Eur J Dermatol. 2007;17:30–2.
Marrakchi S, Bouassida S, Meziou TJ, et al. An objective method for the assessment of vitiligo treatment. Pigment Cell Melanoma Res. 2008;21:106–7.
Lai LG, Xu AE. In vivo reflectance confocal microscopy imaging of vitiligo, nevus depigmentosus and nevus anemicus. Skin Res Technol. 2011;17:404–10.
Sharquie KE. Stages of depigmentation in vitiligo. Iraqi Med J. 1988;36:47–50.
Anbar TS, El-Sawy AE, Attia SK, Moftah NH, El-Tonsy MH. Patterns of repigmentation in two cases of hypopigmented type of vitiligo. Photodermatol Photoimmunol Photomed. 2009;25:156–8.
Parsad D, Pandhi R, Dogra S, Kumar B. Clinical study of repigmentation patterns with different treatment modalities and their correlation with speed and stability of repigmentation in 352 vitiliginous patches. J Am Acad Dermatol. 2004;50:63–7.
Kim DY, Cho SB, Park YK. Various patterns of repigmentation after narrowband UVB monotherapy in patients with vitiligo. J Dermatol. 2005;32:771–2.
Yang YS, Cho HR, Ryou JH, Lee MH. Clinical study of repigmentation patterns with either narrow-band ultraviolet B (NBUVB) or 308 nm excimer laser treatment in Korean vitiligo patients. Int J Dermatol. 2010;49:317–23.
Hann SK, Kim YS, Yoo JH, Chun YS. Clinical and histopathologic characteristics of trichrome vitiligo. J Am Acad Dermatol. 2000;42:589–96.
Tel-D Anbar, Abdel-Raouf H, Awad SS, Ragaie MH. Perifollicular inflammatory infiltrate in vitiligo. Int J Dermatol. 2011;50:234–7.
Sharquie KE, Mehenna SH, Naji AA, Al-Azzawi H. Inflammatory changes in vitiligo: stage I and II depigmentation. Am J Dermatopathol. 2004;26:108–12.