Clinical Markers of Vitiligo Tied to Disease Progression

By Will Boggs MD

January 28, 2020

NEW YORK (Reuters Health) - The presence of at least one established clinical marker of vitiligo is associated with disease progression at follow-up, researchers from China report.

"The presence of clinical markers, including trichrome sign, confetti-like depigmentation, and Koebner phenomenon in patients with vitiligo may be associated with worse and rapid disease progression," Dr. Chengfang Zhang of Huashan Hospital, Fudan University, in Shanghai, told Reuters Health by email.

Disease progression in vitiligo, an acquired depigmentation disorder affecting 0.5% to 2.0% of the global population, is unpredictable. The chemokine CXCL10 is a potential biomarker for differentiating stable and active vitiligo, but whether clinical markers are associated with disease activity and prognosis remains unclear.

Dr. Zhang and colleagues evaluated the value of trichrome sign, confetti-like depigmentation and Koebner phenomenon in assessing the stage, progression, severity, and prognosis of vitiligo in their study of 425 patients with vitiligo.

Overall, 201 patients (47.3%) had at least one of these clinical markers. Significantly more patients with at least one clinical marker had active vitiligo at baseline (97.5% vs. 71.0%) and at the three-month follow-up (45.3% vs. 23.2%).

Disease progression at one month (70.6% vs. 26.8%) and at three months (31.3% vs. 4.0%) was also significantly more common among patients with clinical markers, the researchers report in JAMA Dermatology.

Serum CXCL10 levels were consistently higher in patients with clinical markers, and the proportion of patients with a baseline Vitiligo Area Scoring Index (VASI) score above 50 was significantly higher among those with a clinical marker.

During follow-up, patients with at least one clinical marker experienced significantly smaller improvements in VASI score and significantly less repigmentation, compared with patients with no clinical markers.

The presence of multiple clinical markers at baseline was associated with a higher rate of active disease at three months' follow-up and with a higher rate of disease progression at one month and three months.

Most disease measures did not differ by the specific clinical marker, but the mean length of progression was significantly longer and the VASI improvement was significantly greater with trichrome sign than with the other markers.

"Patients exhibiting multiple clinical markers may require more intensive treatment," Dr. Zhang said.

Dr. John E. Harris of the University of Massachusetts Medical School's Vitiligo Clinic and Research Center, in Worcester, told Reuters Health by email, "Simple observations made by dermatologists in the clinic have the ability both to predict how vitiligo will progress as well as respond to treatment. While those of us who see a lot of vitiligo patients suspected these observations were true, we now have solid data on which to base our decision-making when optimizing management for patients."

"If they have any one of the three described clinical signs of activity, patients must be treated aggressively to prevent rapid spread and the possibility of permanent damage," he said.

"This report does not show the severe worsening of vitiligo in those with clinical signs of activity because all patients were treated aggressively," Dr. Harris said. "So, the worse prognosis in patients with active signs reported here occurred despite aggressive therapy. We know from earlier, smaller studies that if patients are not treated aggressively, disease progression can be lightning fast and potentially devastating for patients."

The study had no commercial funding.

SOURCE: JAMA Dermatology, online January 22, 2020.