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

Geel, Nanja van; Passeron, Thierry; Wolkerstorfer, Albert; Speeckaert, Reinhart; Ezzedine, Khaled

doi:10.1111/bjd.18950

Cited by 36 publications

(56 citation statements)

References 21 publications

(50 reference statements)

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“…Clinical markers of active, progressive disease should be thought and include: the Koebner phenomenon, inflammatory lesions, trichrome lesions, and confetti‐like depigmentation (Figure 3) 34,127,173–175 . The Vitiligo Signs of Activity Score (VSAS), which is a composite score based on the presence of confetti‐like depigmentation, Koebner phenomenon and hypochromic areas/borders in 15 body areas, is a reliable instrument to score visible clinical signs linked to disease activity and was recently validated 179 . Treatment for at least 2–3 months is needed to determine its efficacy.…”

Section: Managementmentioning

confidence: 99%

Vitiligo: A focus on pathogenesis and its therapeutic implications

Bergqvist

Ezzedine

2021

The Journal of Dermatology

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140

106

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Vitiligo is the most common depigmenting disorder affecting 0.1%–2% of the population worldwide. The characteristic white patches result from the selective loss of melanocytes. Sustained recent efforts have resulted in a detailed understanding of the genetic architecture of vitiligo. About 80% of vitiligo risk is attributable to genetic factors; and the rest (20%) is attributable to the environment. Over the past decade, substantial progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Melanocytes from patients with vitiligo are more susceptible to oxidative stress which begets the release of exosomes and inflammatory cytokines that will lead to activation of the innate immune response and subsequently to adaptive immune response through activation of autoreactive cytotoxic CD8+ T cells. These produce interferon‐γ (IFN‐γ) which promotes disease progression through IFN‐γ‐induced chemokine secretion from surrounding keratinocytes to further recruit T cells to the skin through a positive feedback loop. CD8 tissue‐resident memory T cells are in turn responsible for long‐term maintenance and potential relapse of vitiligo in human patients through cytokine‐mediated recruitment of T cells from the circulation. This review summarizes the current knowledge on vitiligo and attempt to give an overview of the future in vitiligo treatment.

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Section: Managementmentioning

confidence: 99%

Vitiligo: A focus on pathogenesis and its therapeutic implications

Bergqvist

Ezzedine

2021

The Journal of Dermatology

Self Cite

140

106

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“…Currently, there is no standardized method to evaluate repigmentation objectively. [42][43][44] Other validated tools, such as Vitiligo Extent Score, recommended by the International Initiative for Outcomes for vitiligo could be used instead. 23,27,33,36,43 Finally, none of the studies evaluated the relevant selfassessment outcomes such as subjective improvement, patients' treatment expectations, quality of life, tolerability, and burden of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…46 This tool is used to assess the cosmetic acceptability of repigmentation in patients with vitiligo. 25,44 Multiple therapies for vitiligo are currently available. 4,45 OMP therapy needs to be standardized so that dermatologists can offer an alternative treatment for this difficult to treat disease.…”

Section: Discussionmentioning

confidence: 99%

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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“…The inclusion criteria were as follows: (i) segmental or non-segmental vitiligo; (ii) stable diseases over at least 1 year; (iii) failure with non-surgical interventions over at least 6 months; and (iv) absence of confetti-like depigmentation, tri-or hypochromic areas, and type B Koebner phenomenon. 12 In total, 50 patients were enrolled. Two patches were selected from each patient and were randomly allocated to the epidermal orientation and dermal orientation groups.…”

Section: Clinical Trialmentioning

confidence: 99%

Skin seeding technique with 0.5‐mm micropunch grafting for vitiligo irrespective of the epidermal–dermal orientation: Animal and clinical studies

Kim¹,

Lee

et al. 2020

The Journal of Dermatology

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Micropunch grafting is the simplest surgical intervention for refractory vitiligo but is tedious and time-consuming. Therefore, we aimed to verify the efficacy and safety of dermal orientation grafting using motorized 0.5-mm micropunch grafting for vitiligo. In a preliminary animal study, 12-week-old rats were used to observe the healing process after the transplantation of dermal orientation grafts with various punch sizes. In a clinical trial, a total of 100 vitiligo patches in 50 patients with stable vitiligo were randomly allocated to motorized 0.5-mm micropunch grafting in epidermal and dermal orientations, respectively. The grafts were implanted at intervals of 5 mm at the recipient site. Treatment success was defined as greater than 75% repigmentation. In the animal study, all grafts were shown to be well integrated into the recipient site within 3 weeks. In the clinical trial, treatment success was achieved in 72% and 76% of the epidermal and dermal orientation groups, respectively; a cobblestone appearance was observed in 4% and 2%, respectively. In conclusion, we demonstrated that this new grafting method irrespective of epidermal-dermal orientation using motorized 0.5-mm micropunch grafting was effective and safe. We have named this the "skin seeding technique" and it differs from traditional punch grafting in that it can be performed regardless of the graft orientation.

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

Cited by 36 publications

References 21 publications

Vitiligo: A focus on pathogenesis and its therapeutic implications

Vitiligo: A focus on pathogenesis and its therapeutic implications

Oral mini‐pulse therapy in vitiligo: a systematic review

Skin seeding technique with 0.5‐mm micropunch grafting for vitiligo irrespective of the epidermal–dermal orientation: Animal and clinical studies

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