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Nirmal B, Antonisamy B, Peter CVD, George L, George AA, Dinesh GM. Cross-Sectional Study of Dermatoscopic Findings in Relation to Activity in Vitiligo: BPLeFoSK Criteria for Stability. J Cutan Aesthet Surg 2019; 12:36-41. [PMID: 31057267 PMCID: PMC6484572 DOI: 10.4103/jcas.jcas_75_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Stability in vitiligo is an important concept in guiding patient management and a vital prerequisite before vitiligo surgery. Disease activity of vitiligo based on patient’s history is imprecise. It is practically impossible to perform biopsy from all lesions of vitiligo to ascertain stability. Dermatoscopy can be used to examine all clinical lesions in a patient of vitiligo. There is a need to validate many reported dermatoscopic findings for universal use. Aims: To analyze the significance of dermatoscopic findings in the activity of vitiligo and to devise a cutoff score for stable vitiligo. Materials and Methods: Dermatoscopic examination was performed in 85 patients clinically diagnosed with vitiligo. Six dermatoscopic parameters, namely, border, pigment network, perilesional hyperpigmentation, perifollicular pigmentation, satellite lesions, and micro-Koebner phenomenon (acronym: BPLeFoSK) were evaluated against Wood’s lamp findings as standard. Chi-square test was used to test association between categorical variables. Cutoff values for stability for these six parameters were plotted in receiver operating curve. Results: A total of 131 vitiligo lesions were analyzed with dermatoscopy. Absence of satellite lesions and absence of micro-Koebner phenomenon were the most sensitive parameters (96.7% and 100%, respectively). Sharp border and absent or reticulate pigment network within the vitiligo patch were the most specific findings (100% and 91.5%, respectively). Conclusion: A cutoff score of more than or equal to 1.5 using the “BPLeFoSK criteria” indicates stability in the vitiligo lesion.
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Affiliation(s)
- Balakrishnan Nirmal
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - C V Dincy Peter
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leni George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu A George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gauri M Dinesh
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
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Benzekri L, Gauthier Y. Clinical markers of vitiligo activity. J Am Acad Dermatol 2017; 76:856-862. [DOI: 10.1016/j.jaad.2016.12.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 10/08/2016] [Accepted: 12/23/2016] [Indexed: 11/28/2022]
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Majid I, Mysore V, Salim T, Lahiri K, Chatterji M, Khunger N, Talwar S, Sachhidanand S, Barua S. Is Lesional Stability in Vitiligo More Important Than Disease Stability for Performing Surgical Interventions? Results from a Multicentric Study. J Cutan Aesthet Surg 2016; 9:13-9. [PMID: 27081244 PMCID: PMC4812882 DOI: 10.4103/0974-2077.178538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Ensuring stability of the disease process is essential for undertaking surgical intervention in vitiligo. However, there is no consensus regarding the minimum duration of stability or the relative importance of disease and lesional stability in selecting patients for vitiligo grafting. Aim: This multicentric study aims to assess the relative importance of lesional and disease stability on selecting patients for vitiligo grafting. Materials and Methods: One hundred seventy patients were recruited into the study and divided into two groups: Group A with lesional stability of >1 year but overall disease stability of only 6-11 months and Group B with overall disease stability of >1 year. Patients underwent either tissue or cellular vitiligo grafting on the selected lesions and the repigmentation achieved was scored from 0 (no repigmentation) to 6 (100% repigmentation). Repigmentation achieved on different sites of the body was compared between the two groups. Adverse effects at both the donor and the recipient sites were also compared. Results: Of the 170 patients who were enrolled, 82 patients were placed in Group A and 88 patients in Group B. Average repigmentation achieved (on scale of 0 to 6) was 3.8 and 4.04 in Group A and Group B, respectively. In Group A, ≥90% repigmentation was achieved in 36.6% (30/82) patients, while 37.5% (33/88) achieved similar results in Group B. Additionally, 47.6% (39/82) and 53.4% (47/88) of cases achieved partial repigmentation in Group A and Group B, respectively. Perigraft halo was the commonest adverse effect observed in both groups. Statistical analysis revealed no significant differences between the two groups with respect to the repigmentation achieved or adverse effects observed. Repigmentation achieved was the best on the face and neck area, while acral areas responded the least. Conclusions: Lesional stability seems to be as relevant as the overall disease stability in selecting patients for surgical intervention in vitiligo.
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Affiliation(s)
- Imran Majid
- CUTIS Institute of Dermatology, Srinagar, Kashmir, India
| | - Venkataram Mysore
- Venkat Charmalaya Centre for Advanced Dermatology and Postgraduate Training, Bangalore, India
| | - Thurakkal Salim
- Cutis Institute of Advanced Dermatology, Calicut, Kerala, India
| | | | | | - Niti Khunger
- Vardhman Mahavir Medical College, Safdarjung Hospital, Delhi, India
| | - Suresh Talwar
- Talwar Skin and Laser Centre, Lucknow, Uttar Pradesh, India
| | - S Sachhidanand
- Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
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Abstract
Stability is a hard-to-define concept in the setting of vitiligo, but is nonetheless extremely crucial to the planning of treatment regimens and also in prognosticating for the patient. There are several ways to judge stability in vitiligo, which include clinical features and, recently, many biochemical, cytological and ultrastructural correlates of the same. These recent advances help in not only in prognosticating individual patients but also in elucidating some of the mechanisms for the pathogenesis of vitiligo, including melanocytorrhagy and oxidative damage to melanocytes.
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Affiliation(s)
- Kanika Sahni
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Benzekri L, Gauthier Y, Hamada S, Hassam B. Clinical features and histological findings are potential indicators of activity in lesions of common vitiligo. Br J Dermatol 2012; 168:265-71. [DOI: 10.1111/bjd.12034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CCE, Goh BK, Anbar T, Silva de Castro C, Lee AY, Parsad D, van Geel N, Le Poole IC, Oiso N, Benzekri L, Spritz R, Gauthier Y, Hann SK, Picardo M, Taieb A. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012; 25:E1-13. [PMID: 22417114 PMCID: PMC3511780 DOI: 10.1111/j.1755-148x.2012.00997.x] [Citation(s) in RCA: 363] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
During the 2011 International Pigment Cell Conference (IPCC), the Vitiligo European Taskforce (VETF) convened a consensus conference on issues of global importance for vitiligo clinical research. As suggested by an international panel of experts, the conference focused on four topics: classification and nomenclature; definition of stable disease; definition of Koebner's phenomenon (KP); and 'autoimmune vitiligo'. These topics were discussed in seven working groups representing different geographical regions. A consensus emerged that segmental vitiligo be classified separately from all other forms of vitiligo and that the term 'vitiligo' be used as an umbrella term for all non-segmental forms of vitiligo, including 'mixed vitiligo' in which segmental and non-segmental vitiligo are combined and which is considered a subgroup of vitiligo. Further, the conference recommends that disease stability be best assessed based on the stability of individual lesions rather than the overall stability of the disease as the latter is difficult to define precisely and reliably. The conference also endorsed the classification of KP for vitiligo as proposed by the VETF (history based, clinical observation based, or experimentally induced). Lastly, the conference agreed that 'autoimmune vitiligo' should not be used as a separate classification as published evidence indicates that the pathophysiology of all forms of vitiligo likely involves autoimmune or inflammatory mechanisms.
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Affiliation(s)
- K Ezzedine
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin Disorders, Hôpital Pellegrin, Bordeaux, France.
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Abstract
Stability is taken as the most important parameter before opting for any transplantation technique to treat vitiligo. But, simultaneous donor site repigmentation and depigmentation of grafts at the recipient site has been noted. Similarly donor site depigmentation with complete repigmentation of the recipient area with pigment growing out from each graft has been observed. Successful repigmentation after regrafting in previous punch failure cases has also been reported. Koebner's phenomenon from history (Kp-h) and test grafting were the only available indicators to assess stability. It is quite ironic to note that even after four decades of experience in vitiligo surgery, there seems to be little consensus among workers regarding the optimal required period of stability. Moreover, the exact concept of stability in vitiligo is itself still not transparent and defined beyond doubt Overdependence on KpH or TG may be sometimes misleading in vitiligo. These two reveal the apparent clinical stability only and that may not be the true reflection of stability status of the disease at the molecular level. Antimelanocyte cytotoxic reactivity was observed among CD8+ TCC isolated from perilesional biopsies of patients with vitiligo. An attempt should be made to clearly fathom and define stability, not merely only on clinical ground but along with electron microscopy and histoenzymological analysis of the perilesional and nonlesional skin of vitiligo patients. Probably some growth factors which are responsible for both mitogenic and melanogenic stimulation of melanocytes should also be taken into account. Some serological test(s) could guide us to measure these growth factors.
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Affiliation(s)
- Koushik Lahiri
- From the Pigmentary Disorder Unit, Rita Skin Foundation, GD 381 Sector III, Salt Lake, Kolkata, India
| | - Subrata Malakar
- From the Pigmentary Disorder Unit, Rita Skin Foundation, GD 381 Sector III, Salt Lake, Kolkata, India
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van Geel N, Speeckaert R, Taieb A, Picardo M, Böhm M, Gawkrodger DJ, Schallreuter K, Bennett DC, van der Veen W, Whitton M, Moretti S, Westerhof W, Ezzedine K, Gauthier Y. Koebner’s phenomenon in vitiligo: European position paper. Pigment Cell Melanoma Res 2011; 24:564-73. [DOI: 10.1111/j.1755-148x.2011.00838.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Koushik Lahiri
- Consultant Dermatologist, Apollo Gleneagles Hospitals, Rita Skin Foundation, Kolkata, West Bengal, India
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Abstract
Vitiligo is a result of disrupted epidermal melanization with an undecided etiology and incompletely understood pathogenesis. Various treatment options have resulted in various degrees of success. Various surgical modalities and transplantation techniques have evolved during the last few decades. Of them, miniature punch grafting (PG) has established its place as the easiest, fastest, and least expensive method. Various aspects of this particular procedure have been discussed here. The historical perspective, the instruments, evolution of mini grafting down the ages, and the methodology, advantages, and disadvantages have been discussed. A detailed discussion on the topic along with a review of relevant literature has been provided in this article.
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Affiliation(s)
- Koushik Lahiri
- Department of Dermatology, Apollo Gleneagles Hospital and Pigmentary Disorder Unit, Rita Skin Foundation, India.
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Lahiri K, Malakar S, Sarma N, Banerjee U. Repigmentation of vitiligo with punch grafting and narrow-band UV-B (311 nm)--a prospective study. Int J Dermatol 2006; 45:649-55. [PMID: 16796620 DOI: 10.1111/j.1365-4632.2005.02697.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Phototherapy is already established as an effective mode of therapy in vitiligo. An evidence-based study was carried out of the effect of narrow-band (311 nm) ultraviolet-B (NB-UV-B) radiation in 66 surgically treated patients with recalcitrant vitiligo in whom autologous mini-punch grafting was deployed. METHODS A total of 2613 grafts were placed over 108 lesions on 17 regions in 66 individuals (39 females and 27 males) with stable, refractory vitiligo. The age range was 21-48 years. Postsurgically, they were exposed to a suberythemal dose of NB-UV-B (311 nm). Different parameters of surgical repigmentation were documented. RESULTS Successful repigmentation was achieved in 57 (86.36%) cases. The appearance of repigmentation (AOR) time in different regions varied between 14 and 32 days, with an overall average of approximately 20.6 days. Maximum pigment spread (MPS) reached 12 mm with an average of 6.5 mm. The relationship between the donor graft area and area of surgical repigmentation was also calculated. Cobblestoning was the most common (31.8%) complication, but improved with time and/or interference. CONCLUSIONS Punch grafting in combination with phototherapy (NB-UV-B, 311 nm) was found to be an easy, safe, inexpensive, and effective method of repigmenting static and stubborn vitiligo. Different facets of punch grafting-induced and phototherapy-aided surgical repigmentation were taken into consideration. The area of repigmentation, MPS, and relationship between the donor graft area and area of surgical repigmentation were documented.
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Affiliation(s)
- Koushik Lahiri
- Pigmentary Disorder Unit, Rita Skin Foundation, Calcutta, India.
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Malakar S, Lahiri K. Spontaneous repigmentation in vitiligo: why it is important. Int J Dermatol 2005. [DOI: 10.1111/j.1365-4632.2005.02657.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malakar S, Lahiri K. Punch Grafting for Lip Leucoderma. Dermatology 2004; 208:125-8. [PMID: 15057001 DOI: 10.1159/000076485] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2001] [Accepted: 10/09/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lip leucoderma (LL) is a common concern of great psychological scarring. The condition is often resistant to medical management due mainly to the absence of hair follicles. Melanocyte transfer, therefore, by any surgical procedure may repigment this condition. OBJECTIVE To repigment LL by punch graft (PG) and to estimate and evaluate the degree of repigmentation and its complications. METHODS One hundred and eight cases of stable and resistant LL of various causes were studied. They were followed up to a maximum of 5 years. RESULTS Graft take was achieved in 98 cases (91%) whereas all the grafts were rejected in 8 cases of herpes-labialis-induced LL (HlLL). Two cases (1.5%) showed depigmentation of grafts. Cobblestoning was the most common complication and was observed in 32 cases (30%). Complete repigmentation was achieved in 78 cases (72%). CONCLUSION PG is a simple office procedure to treat LL. The procedure should exclude HILL.
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Affiliation(s)
- Julie V Schaffer
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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Affiliation(s)
- Andreas Katsambas
- Department of Dermatology, University of Athens, A Sygros Hospital, Athens, Greece.
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