Repigmentation of Extensive Inflammatory Vitiligo with Raised Borders Using Early and Aggressive Treatment

Gunasekera, Nicole; Murphy, Gëorge F.; Sheth, Vaneeta M.

doi:10.1159/000366197

Cited by 6 publications

(12 citation statements)

References 12 publications

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“…In case of KP, it has been suggested that this sign preludes the development to mixed vitiligo, which also supports the theory that segmental and non‐segmental vitiligo may reflect different variants on a single disease spectrum . The effect of skin manifestations on treatment response was not assessed in this systematic review, although some suggested that the presence of inflammatory vitiligo with raised borders should be tackled with early and aggressive treatment …”

Section: Discussionmentioning

confidence: 99%

“…47 The effect of skin manifestations on treatment response was not assessed in this systematic review, although some suggested that the presence of inflammatory vitiligo with raised borders should be tackled with early and aggressive treatment. 48 The reported prevalence of the different skin manifestations varied, as well as the association with disease activity, suggesting different definitions and assessment methods of these clinical signs in the different studies. This was also reflected in the heterogeneity parameter of the meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

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Clinical visible signs of disease activity in vitiligo: a systematic review and meta‐analysis

Geel

Grine

Wispelaere

et al. 2019

Acad Dermatol Venereol

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Vitiligo is an unpredictable depigmenting disorder for which a static method to assess disease activity is lacking. Presence of certain skin manifestations may be indicative of disease activity. Here, we evaluated the current evidence for an association between clinical signs and reported disease activity in vitiligo. A systematic review and meta‐analysis was performed based on a search in PubMed, Embase and Cochrane Library. Literature reporting skin manifestations and disease activity was analysed based on descriptive analyses and, if applicable, odd ratios. Forty‐six observational studies were selected and analysed, including 28 case reports. Reported clinical signs in relation to active vitiligo were as follows: Koebner's phenomenon, confetti‐like depigmentations, tri‐ and hypochromic lesions (including poorly defined borders), inflammatory borders/areas, itch and leukotrichia. Based on this search, strong evidence was found for Koebner's phenomenon. Poorly defined borders and confetti lesions are potential markers, although more data are needed to confirm this. Evidence for other skin manifestations was inconclusive, whereas case reports on inflammatory borders were indicative of active disease. Limitations included the lack of randomized controlled trials, large‐scale prospective studies and heterogeneity due to inconsistent definitions. This systematic review urges the vitiligo community to come forward with consensus‐based definitions as well as a reliable scoring system to assess these clinical signs and to design optimal trials to investigate their true predictive value.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical visible signs of disease activity in vitiligo: a systematic review and meta‐analysis

Geel

Grine

Wispelaere

et al. 2019

Acad Dermatol Venereol

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“…This is supported by the fact that late treatment would deprive the patients of chances for complete repigmentation. [11][12][13][14]17 Fortunate enough, successful repigmentation as defined by Gan et al 19 was achieved in all patients in a mean duration of 6.88 months.…”

Section: Discussionmentioning

confidence: 73%

“…In the current study, we considered a single vitiligo patch as an “emergency” situation opting for better response aiming at lower incidence of recurrence even in resistant cases as acral and segmental vitiligo. This is supported by the fact that late treatment would deprive the patients of chances for complete repigmentation 11–14,17 …”

Section: Discussionmentioning

confidence: 99%

“…The need for early treatment in vitiligo was highlighted by Lee et al to guarantee better response in both acral and non‐acral vitiligo 10,11 . This approach was reported to halt activity as well as achieve adequate repigmentation in inflammatory vitiligo 11,12 . This was ascertained by further studies confirming that recent onset vitiligo carries a favorable clinical response to treatment 14,15 as well as a more likely spared follicular melanocyte reservoir 16 …”

Section: Introductionmentioning

confidence: 99%

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Early localized vitiligo, a medical emergency: Long‐term follow‐up study

Esmat

Bassiouny

Hegazy

et al. 2021

Dermatologic Therapy

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In spite of multiple therapeutic regimens for vitiligo, disease relapse remains a challenge. Most guidelines consider systemic treatments only in rapidly progressive disease with wider surface areas. This delay in halting the immune attack, may give the chance for further disease progression as well as establishment of resident memory T‐cell population predisposing to future relapses. To assess the ability of early systemic therapy of localized (<2% BSA), recent onset (<6 months) vitiligo to control disease activity and minimize the possibility of recurrence. Twenty‐five patients with recent onset (<6 months), localized (<2% BSA) vitiligo were included. Patients received pulse dexamethasone therapy for 6 months plus topical treatments and NB‐UVB sessions. Patients were followed monthly as regards percent of repigmentation and VIDA score. To detect recurrence, biannual assessment was done for 4 years. Eighty‐four percent of patients had acrofacial lesions and 44% had facial lesions. Arrest of activity was achieved after 3.65 ± 2.19 months. Complete repigmentation was achieved in a mean duration of 6.88 ± 0.2 months. At the end of the 4‐year follow up, recurrence occurred in 32% of patients. In spite of recurrence, localized disease (<2% BSA) was secured. A significantly higher incidence of recurrence was associated with cases with bilateral distribution of lesions. Early systemic immunomodulation for recent localized vitiligo is a successful approach to achieve early control of disease activity and minimize the incidence of recurrence. Such cases should not be overlooked but managed as early as possible; it is a race against time.

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