Clinical markers in vitiligo associated with worse prognosis: JAMA
China: The presence of clinical markers including trichrome sign, confetti-like depigmentation, and Koebner phenomenon in vitiligo patients is associated with worse prognosis and rapid disease progression, a recent study in the journal JAMA Dermatology has suggested. The study further found that patients with multiple clinical markers may require more intensive treatment.
Vitiligo is a common autoimmune disease that causes the loss of skin colour in blotches. It affects about 0.5% to 1% of the population and is associated with low self-esteem and social stigma. The association between clinical markers and disease activity, severity, and the prognosis is poorly understood.
Li Zhang, Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China, and colleagues evaluated the utility of trichrome sign, confetti-like depigmentation, and Koebner phenomenon in assessing disease progression, severity, and prognosis in patients with vitiligo.
This prospective cohort study involved 425 patients with vitiligo. The patients were recruited from the outpatient department of Huashan Hospital, Fudan University in Shanghai, China, from September 1, 2016, to May 13, 2019.
Primary outcomes included disease progression, severity and prognosis during a follow-up of 12 months.
The active stage of vitiligo was defined as Vitiligo European Task Force spreading score of at least 1 or more lesions appearing as hypomelanotic with poorly defined borders using a Wood light. Progression was assessed using the Vitiligo Area Scoring Index (VASI) and serum CXCL10 level measurement.
Key findings of the study include:
· Of the 425 patients (224 with no clinical marker and 201 with at least 1 clinical marker) included in this analysis, the proportion in the active stage of the disease was significantly higher in the cohort with at least 1 clinical marker compared with the cohort without any clinical marker at the first visit (196 of 201 [97.5%] vs 159 of 224 [71.0%]) and at 3-month follow up (91 of 201 [45.3%] vs 52 of 224 [23.2%]).
· The proportion of patients with rapid disease progression was also higher in the group with at least 1 clinical marker at 1-month follow-up (142 of 201 [70.6%] vs 60 of 224 [26.8%]) and 3-month follow-up (63 of 201 [31.3%] vs 9 of 224 [4.0%]).
· The improvement in VASI score (SD) was significantly smaller among patients with at least 1 clinical marker compared with those without any clinical marker at 6 months (mean [SD], 0.14 vs 0.23), at 9 months (mean [SD], 0.29 vs 0.44), and at 12 months (mean [SD], 0.47 vs 0.63).
"The presence of a clinical marker in patients with vitiligo may be associated with worse prognosis and rapid disease progression. Patients with multiple clinical markers may require more intensive treatment," concluded the authors.
The study, "Association of Clinical Markers With Disease Progression in Patients With Vitiligo From China," is published in the journal JAMA Dermatology.