Lack of correlation of the patient-derived Vitiligo Disease Activity Index with the clinician-derived Vitiligo Area Scoring Index

Coias, Jennifer; Hynan, Linda S.; Pandya, Amit G.

doi:10.1016/j.jaad.2017.11.034

Cited by 12 publications

(14 citation statements)

References 6 publications

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“…20,21 However, VIDA has been criticized since it is based on the patient's opinion. 41 Moreover, VIDA score was not found to be correlated with disease activity. 33,41 The VASI is not a validated scale and has been demonstrated to lack precision.…”

Section: Discussionmentioning

confidence: 94%

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Oral mini‐pulse therapy in vitiligo: a systematic review

et al. 2021

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Background There is limited evidence supporting the use of alternative treatments for patients with nonstable vitiligo.Objective This study aimed to review the effects of oral mini-pulse (OMP) therapy in the management of nonsegmental vitiligo. MethodsThe following databases were searched between inception and May 2020 for relevant studies: Scopus, Web of Science, MEDLINE, and Embase. All randomized controlled trials that compared OMP therapy with any other active treatment or placebo for nonstable vitiligo were included. The Cochrane's risk of bias tool was used to evaluate the risk of bias (ROB) in selected studies, and the overall quality of evidence of each outcome was assessed using the Grading Recommendations, Assessment, Development, and Evaluations (GRADE) system.Results Four studies met our selection criteria. All of them were conducted in India and included 246 patients. OMP therapy included betamethasone or dexamethasone. The duration of treatment was 6 months in all studies. Up to 32% of patients achieved a repigmentation rate of >75% when OMP therapy was administered as monotherapy. No difference was observed between OMP therapy and other treatments in arresting the disease, and weight gain was the most frequent adverse effect. The overall ROB in all included studies was relatively high because of the randomization process, outcome measurement and informed selection of outcomes. ConclusionBased on the findings of these studies, OMP therapy did not demonstrate additional value compared with other treatments. Hence, there is an urgent need to conduct high-quality clinical trials to evaluate this therapy.

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Section: Discussionmentioning

confidence: 94%

“…41 Moreover, VIDA score was not found to be correlated with disease activity. 33,41 The VASI is not a validated scale and has been demonstrated to lack precision. Currently, there is no standardized method to evaluate repigmentation objectively.…”

Section: Discussionmentioning

confidence: 94%

Oral mini‐pulse therapy in vitiligo: a systematic review

et al. 2021

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“…However, in the present study, we assume minimal contribution of “altered” immune cells in the skin as all the 12 included cases had “stable” lesions. However, the “stability” of the disease was determined based on patient recall along with the absence of Koebner phenomenon (as noted by the clinician) and not determined by clinician‐derived vitiligo area scoring index …”

Section: Discussionmentioning

confidence: 99%

Lesional skin in vitiligo exhibits delayed in vivo reepithelialization compared to the nonlesional skin

Gupta

Chauhan

Priya

et al. 2020

Wound Repair Regeneration

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Vitiligo, a common skin disorder, is characterized by the loss of functional melanocytes resulting in the depigmentation of skin. Previous studies have demonstrated molecular and architectural alterations in the epidermal keratinocytes upon loss of melanocytes. The physiological implications of these "altered" keratinocytes are yet not known. We investigated the wound healing efficiency of lesional vs nonlesional skin in 12 subjects with stable nonsegmental vitiligo using histological and ultrastructural evaluation of partial-thickness wounds. The wounds were examined 12 days postinjury, coinciding with the reepithelialization phase of healing marked primarily by keratinocyte migration and proliferation. This study demonstrated a significant difference in the reepithelialization potential between the lesional and nonlesional skin. While all 12 nonlesional wounds demonstrated considerable neoepidermis formation on the 12th day post wound, only four of the corresponding lesional samples showed comparable reepithelialization; the rest remaining in the inflammatory phase. Ultrastructural studies using transmission electron microscopy as well as immunohistochemical staining revealed a reduced number of desmosomes, shorter keratin tonofilaments and an increase in myofibroblast population in the dermis of lesional reepithelialized tissue compared to the nonlesional reepithelialized samples. This study implicates gross functional perturbations in the lesional skin during physiological wound healing in vitiligo, suggesting that the breakdown of keratinocytemelanocyte network results in delayed wound repair kinetics in the lesional skin when compared to patient-matched nonlesional skin.

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“…However, this VIDA score was demonstrated to be unreliable. 9 No validation studies on physician-reported outcome measures specifically designed to score signs linked to disease activity in a combined score have been reported so far in vitiligo.…”

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confidence: 99%

“…So far, the Vitiligo Disease Activity Index (VIDA) score is the most frequently cited measurement instrument by researchers, although it is constructed as a recall‐based patient‐reported outcome measure. However, this VIDA score was demonstrated to be unreliable 9. No validation studies on physician‐reported outcome measures specifically designed to score signs linked to disease activity in a combined score have been reported so far in vitiligo.…”

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confidence: 99%

Reliability and validity of the Vitiligo Signs of Activity Score (VSAS)

et al. 2020

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Summary Background The associations between disease activity and several clinical signs in vitiligo have been described, but a widely accepted and validated scoring system is lacking. Objectives To validate the Vitiligo Signs of Activity Score (VSAS) for physicians. Methods Three visible clinical signs were scored on 15 body locations: confetti‐like depigmentation (c), Koebner phenomenon (k) and hypochromic areas/borders (h). The inter‐ and intrarater reliability of the global VSAS and VSAS subscores (c‐VSAS, k‐VSAS and h‐VSAS) were tested by four and three raters (physicians), respectively. Construct validity and feasibility were evaluated. Results The VSAS demonstrated good inter‐rater reliability, with an intraclass correlation coefficient (ICC) of 0·87 in the first round and 0·90 in the second round. The intrarater reliability ICCs were all ≥ 0·86. The inter‐rater reliabilities of the subscores were excellent for c‐VSAS and fair for k‐VSAS and h‐VSAS (ICC 0·83, 0·51 and 0·53, respectively, in the first round). Evidence for construct validity was provided. The completion time by the raters (median 2·18 min per patient) improved during the second round (median 1·33 min per patient). A limitation of the study is the low number of patients, mainly of skin phototypes II–III, from a single tertiary centre. Conclusions The VSAS appears to be a valid and reliable instrument to score visible clinical signs linked to disease activity in a standardized way. What is already known about this topic? Evidence exists for a possible link between several visible clinical signs in vitiligo and disease activity. A widely accepted and validated scoring system to quantify these clinical signs is lacking. What does this study add? The Vitiligo Signs of Activity Score (VSAS) underwent preliminary validation and may assist quantification of visible clinical signs linked to disease activity in a standardized way in clinical practice and trials. What are the clinical implications of this work? VSAS may be used for future trials that aim to establish the clinical significance of the specific visible clinical signs in vitiligo in a more controlled setting. Linked Comment: Eleftheriadou. Br J Dermatol 2020; 183:801–802.

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Lack of correlation of the patient-derived Vitiligo Disease Activity Index with the clinician-derived Vitiligo Area Scoring Index

Cited by 12 publications

References 6 publications

Oral mini‐pulse therapy in vitiligo: a systematic review

Oral mini‐pulse therapy in vitiligo: a systematic review

Lesional skin in vitiligo exhibits delayed in vivo reepithelialization compared to the nonlesional skin

Reliability and validity of the Vitiligo Signs of Activity Score (VSAS)

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