Clinical features and histological findings are potential indicators of activity in lesions of common vitiligo

• Published in: British journal of dermatology (1951) Vol. 168; no. 2; pp. 265 - 271
• Main Authors: Benzekri, L., Gauthier, Y., Hamada, S., Hassam, B.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2013; Wiley-Blackwell
• Subjects: Adult; Biological and medical sciences; Biopsy; Dermatology; Female; Humans; Male; Medical sciences; Pigmentary diseases of the skin; Prospective Studies; Skin - pathology; Vitiligo - pathology; Symptomatology; Skin disease; Vitiligo; Pigmentation disorder; Dermatology; Lesion; Indicator
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.12034

Summary Background  Unstable vitiligo lesions are usually considered to be contraindications for surgical treatment. Unfortunately, in the majority of common vitiligo cases, neither accurate clinical signs nor routine blood tests are available to determine whether or not the disease is active. Objectives  To establish a direct correlation between the clinical aspect of vitiligo lesions and their activity. Methods  This was a prospective observational study that took place over 1 year. For each patient, a standardized evaluation included both a careful daylight and Wood’s lamp examination, pictures, biopsies performed at the marginal area and histological and immunohistological studies. A second examination to assess the activity of the lesions correctly was performed 1 year after inclusion in the study. Both the clinical changes and the histological features of the lesions in actively spreading vitiligo were compared with those in stable vitiligo. Results  This study included 50 patients. The lesions were classified as hypomelanotic with poorly defined borders (HPDB, 29 cases) or amelanotic with sharply demarcated borders (ASDB, 21 cases). One year after the biopsy, of the 48 patients still in the study, 20 had lesions that were considered to be stable and 28 had active lesions. Correlations were successfully obtained between clinical aspects, histological findings and vitiligo activity. The HPDB and ASDB lesions were correlated respectively with active and stable status (P < 0·001). Conclusions  A simple clinical examination including a Wood’s lamp examination may allow reliable and efficient evaluation of the stability of vitiligo lesions. What’s already known about this topic? •  Until now, the global assessment for the stability of vitiligo lesions, using three indicators (history, Koebner phenomenon and test grafting), has often proven imprecise and is difficult to perform in daily clinical practice. What does this study add? •  We propose that a simple clinical examination, including use of a Wood’s lamp, may allow reliable and efficient evaluation of the stability of vitiligo lesions.