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Original Investigation
January 22, 2020

Association of Clinical Markers With Disease Progression in Patients With Vitiligo From China

Author Affiliations
  • 1Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
JAMA Dermatol. Published online January 22, 2020. doi:10.1001/jamadermatol.2019.4483
Key Points

Question  Can the clinical markers of vitiligo be used to assess disease progression, severity, and patient prognosis?

Findings  In this cohort study of 458 patients with vitiligo from China, among 425 patients who completed 12-month follow-up, 224 (52.7%) did not have any clinical marker and 201 (47.3%) had at least 1 clinical marker at the first visit. The proportion of patients in the active stage was significantly higher in the cohort with clinical markers compared with the cohort without any marker at the baseline examination and at 3-month follow-up; presence of clinical markers was also associated with disease progression at 1- and 3-month follow-up

Meaning  The findings suggest that clinical markers, including trichrome sign, confetti-like depigmentation, and Koebner phenomenon, are associated with vitiligo progression and prognosis and that patients with multiple clinical markers may require more intensive treatment.

Abstract

Importance  It is necessary to determine whether established clinical markers of vitiligo are associated with disease progression, severity, and patient prognosis.

Objective  To evaluate the utility of trichrome sign, confetti-like depigmentation, and Koebner phenomenon in assessing disease progression, severity, and prognosis in patients with vitiligo.

Design, Setting and Participants  In this prospective cohort study, 425 patients with vitiligo were recruited from the outpatient department of Huashan Hospital, Fudan University in Shanghai, China, from September 1, 2016, to May 13, 2019.

Main Outcomes and Measures  Disease progression, severity, and prognosis during a 12-month period. The active stage of vitiligo was defined as Vitiligo European Task Force spreading score of at least 1 or more lesions appearing as hypomelanotic with poorly defined borders using a Wood light. Progression was assessed using the Vitiligo Area Scoring Index (VASI) and serum CXCL10 level measurement.

Results  Of the 458 enrolled patients, 425 (235 female [55.3%]; mean [SD] age, 30.9 [10.2] years) completed the 12-month follow-up. Of the 425 patients (224 with no clinical marker and 201 with at least 1 clinical marker) included in this analysis, the proportion in the active stage of the disease was significantly higher in the cohort with at least 1 clinical marker compared with the cohort without any clinical marker at the first visit (196 of 201 [97.5%] vs 159 of 224 [71.0%]; P < .001) and at 3-month follow up (91 of 201 [45.3%] vs 52 of 224 [23.2%]; P < .001). The proportion of patients with rapid disease progression was also higher in the group with at least 1 clinical marker at 1-month follow-up (142 of 201 [70.6%] vs 60 of 224 [26.8%]; P < .001) and 3-month follow-up (63 of 201 [31.3%] vs 9 of 224 [4.0%]; P < .001). The improvement in VASI score (SD) was significantly smaller among patients with at least 1 clinical marker compared with those without any clinical marker at 6 months (mean [SD], 0.14 [0.12] vs 0.23 [0.21]; P = .02), at 9 months (mean [SD], 0.29 [0.19] vs 0.44 [0.25]; P = .03), and at 12 months (mean [SD], 0.47 [0.21] vs 0.63 [0.23]; P = .03).

Conclusions and Relevance  The presence of a clinical marker in patients with vitiligo may be associated with worse prognosis and rapid disease progression. Patients with multiple clinical markers may require more intensive treatment.

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