Differentiating active from stable vitiligo: the role of dermoscopic findings and their relation to CXCL-10

A Prospective Study of Dermoscopic and Ultrastructural Features of Vitiligo-Associated Leukotrichia

Background

Dermoscopic and ultrastructural features of vitiligo-associated leukotrichia (VAL) have not been well studied. This study is aimed at the dermoscopic and ultrastructural features of VAL.

Methods

We present a cross-sectional study of VAL-related dermoscopic signs and their relationship with disease stages and duration of leukotrichia. Characteristics of hair surface and finer details including melanosomes, macrofibrils, and remnant nucleus were observed under Electron Microscopy (EM).

Results

One hundred and forty samples on distinct sites from 100 patients were collected. Among 75 VAL from the scalp, the prevalence of diameter diversity of leukotrichia (52.6% vs 8.1%), Pohl-Pinkus constrictions (34.2% vs 0), and depigmented hair roots signs (34.2% vs 8.1%) in patients with progressive vitiligo was much higher than that in patients with stable vitiligo (all P<0.05). The EM result of VAL showed that melanosomes were smaller with vesicles formation, reduced counts, and incomplete shape, and macrofibrils were irregularly arranged with widened spaces and vesicles formation.

Limitations

No conclusions about the histopathologic characteristics or dermoscopic-histopathologic correlation of the VAL.

Conclusion

The dermoscopic signs of diameter diversity of leukotrichia, Pohl-Pinkus constrictions, and depigmented hair roots are related to progressive vitiligo. The process of melanin synthesis and formation of VAL are impaired at the early stage of VAL under Electron microscopy.

A New Assessment Method of Vitiligo by Combination of Dermoscopy and Reflectance Confocal Microscopy

Purpose

The aim is to investigate the application value of dermoscopy combined with reflectance confocal microscopy (RCM) in assessing vitiligo disease activity and treatment response.

Patients and Methods

We enrolled 279 patients with vitiligo and evaluated the disease activity by Vitiligo Disease Activity (VIDA) score, dermoscopy, RCM and dermoscopy combined with RCM respectively. The sensitivity and specificity of different assessment techniques were compared with VIDA score by the differences and consistency. The different characteristics of dermoscopy and RCM with different treatment responses were also analyzed.

Results

The results showed that the sensitivity and specificity of dermoscopy combined RCM were higher than RCM or dermoscopy alone (P values less than 0.05). In the repigmentation process, leukotrichia, pigment network absent and perilesional hyperpigmentation under dermoscopy at the baseline suggested a poor treatment response, while the incompletely disappearing pigment rings under RCM and perifollicular hyperpigmentation under dermoscopy indicated a good treatment response. We also found the proportion of patients with telangiectasia, increased pigment at the lesions and around the hair follicles was significantly higher in the good treatment response group than that in the poor one by dermoscopy (χ2 = 4.423, 32.471, 4.348, P = 0.035 0.000, 0.037) and by RCM the proportion of patients with both increased pigment granules and dendritic melanocytes in the good treatment response group was higher than that in the poor one (χ2 = 38.215, 5.283, P = 0.000, 0.022, respectively).

Conclusion

With the higher sensitivity and specificity than dermoscopy or RCM alone, a combination of dermoscopy and RCM may be a new more accurate measure to assess the vitiligo disease activity and the treatment response.

Non-invasive skin measurement methods and diagnostics for vitiligo: a systematic review

Vitiligo is a multifaceted autoimmune depigmenting disorder affecting around 0.5 to 2.0% of individuals globally. Standardizing diagnosis and therapy tracking can be arduous, as numerous clinical evaluation methods are subject to interobserver variability and may not be validated. Therefore, there is a need for diagnostic tools that are objective, dependable, and preferably non-invasive.

Aims

This systematic review provides a comprehensive overview of the non-invasive objective skin measurement methods that are currently used to evaluate the diagnosis, severity, and progression of vitiligo, as well as the advantages and limitations of each technique.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used for the systematic review. Scopus, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for non-invasive imaging and biophysical skin measuring methods to diagnose, evaluate the severity of, or monitor the effects of vitiligo treatment. The risk of bias in included articles was assessed using the QUADAS-2 quality assessment scale.

Results

An extensive literature search resulted in 64 studies for analysis, describing eight imaging techniques (reflectance confocal microscopy, computer-aided imaging analysis, optical coherence tomography, infrared photography, third-harmonic generation microscopy, multiphoton microscopy, ultraviolet light photography, and visible light/digital photograph), and three biophysical approaches (dermoscopy, colorimetry, spectrometry) used in diagnosing and assessing vitiligo. Pertinent information about functionality, mechanisms of action, sensitivity, and specificity was obtained for all studies, and insights into the strengths and limitations of each diagnostic technique were addressed. Methodological study quality was adequate; however, statistical analysis was not achievable because of the variety of methods evaluated and the non-standardized reporting of diagnostic accuracy results.

Conclusions

The results of this systematic review can enhance clinical practice and research by providing a comprehensive overview of the spectrum of non-invasive imaging and biophysical techniques in vitiligo assessment. Studies with larger sample sizes and sound methodology are required to develop verified methods for use in future practice and research.

Systematic review registration

(PROSPERO) database, (CRD42023395996).