Dermoscopic and Clinical Response Predictor Factors in Nonsegmental Vitiligo Treated with Narrowband Ultraviolet B Phototherapy: A Prospective Observational Study

Abstract

Introduction: Few data on possible local factors that can influence the achievement of response in nonsegmental vitiligo (NSV) treated with narrowband ultraviolet B (Nb-UVB) phototherapy are available. Our objective is to evaluate possible correlations between therapeutic outcomes and dermoscopic and local (lesional) clinical findings of vitiligous lesions undergoing Nb-UVB phototherapy to find positive and/or negative response predictor factors to such treatment. Methods: For each target patch, we calculated the extension area using a computer-aided method and assessed dermoscopic and local (lesional) clinical findings at baseline. After 30 phototherapy sessions (twice weekly), surface area of the lesions was reevaluated to assess clinical improvement, correlating the therapeutic outcome with initial clinical and dermoscopic features. Results: A total of 70 lesions were finally included in the study. At the end of therapy, 18 patches (25.7%) achieved improvement, and the presence of perifollicular pigmentation on baseline dermoscopic examination was found to be associated with a 12-fold higher probability of having a positive therapeutic outcome. Similarly, face localization was also correlated with clinical amelioration, with a sevenfold higher probability for improvement. No association (p [ 0.05) between therapeutic outcomes (either good or poor) and other dermoscopic or local clinical variables (including leukotrichia) was observed. Conclusions: Therapeutic response of vitiligo to Nb-UVB phototherapy may be positively affected by local features of the lesions, i.e., face localization and presence of perifollicular pigmentation on baseline dermoscopic examination, which might be considered as positive response predictor factors to optimize treatment of vitiligo.

Dermoscopy in Monitoring and Predicting Therapeutic Response in General Dermatology (Non-Tumoral Dermatoses): An Up-To-Date Overview

“…That finding was confirmed in a study on patients suffering from segmental vitiligo treated with either medical (phototherapy or laser therapy) or surgical treatments [47], yet it was not seen in another study investigating patients with non-segmental vitiligo treated with ultraviolet B phototherapy, which only found a correlation between positive response and dermoscopic evidence of perifollicular pigmentation at baseline (Fig. 10) [48].…”

“…Finally, dermoscopic examination has also been shown to be useful to predict therapeutic outcomes [46][47][48]. In particular, a recent study showed a reduced response rate to excimer laser therapy of non-segmental vitiligous lesions Fig.…”

Vitiligo Skin Biomarkers Associated With Favorable Therapeutic Response

“…Given that recent research showed that preservation of perifollicular pigmentation under dermatoscope ( 47 ), we evaluated if there were more residual melanocytic biomarkers in lesions of good therapeutic response or short duration. As shown in Figure 2 , all of the melanocyte marker genes showed a trend of higher residual level of expression in good response and short duration lesions, the degree of higher expression did not reach the level of statistical significance (p>0.05, two tailed t test), suggesting the level of residual melanocytic marker genes cannot be reliably used to predict therapeutic response.…”

“…The relationship between lesional skin pigmentation and the patient’s therapeutic response to vitiligo therapy has been unclear as the existing literature provided conflicting conclusions. On the one hand, vitiligo lesions with peri-follicular pigmentation under dermatoscope is associated with more favorable response ( 47 ). On the other, the degree of depigmentation in general did not show correlation to NBUVB therapy ( 50 ).…”

Dermoscopy of acquired pigmentary disorders: a comprehensive review

“…Errichetti et al note the presence of several features on dermoscopy that are often not visualized by the unaided eye and thus not appreciated clinically. 49 In this study, 70 vitiliginous patches were visualized both dermoscopically and clinically. 49 Perifollicular pigmentation was noted in 21.4% of the lesions when evaluated under dermoscopy and only 4.3% when evaluated clinically.…”