Stability: Concept, relevance, inducing and maintaining it

Abstract

Vitiligo is an autoimmune disease resulting in destruction of melanocytes which leads to depigmented patches on the skin. An assessment of disease activity and/or stability is important for many reasons, one of them being planning surgical intervention. Though there are sufficient studies in the literature exploring the clinical, biochemical, and molecular predictors of disease stability, there still exists ambiguity in many of these aspects. There are no longitudinal prospective cohort studies to assess the course of vitiligo and it is difficult to predict the status of stability of the disease with certainty. This review focuses on the clinical features which can help a clinician judge whether the disease is progressive in a patient being planned for surgical intervention. Subsequently, there is also a discussion on tools including ultraviolet light photography, imaging software, and dermoscopy in accurately assessing the stability of disease. This is followed by a review of the literature on the biochemical, serological, microscopic, and ultrastructural findings in active versus static disease. The review ends with interventions for inducing and maintaining stability in this enigmatic disease.