The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force

Abstract

Vitiligo is the most common depigmenting disorder, which affects 0.5-1% of the worldwide population, causing disfigurement and serious disturbances in well being. There is a current lack of consensus in definition and methods of assessment of this disorder, which makes it generally impossible to compare the outcomes of different studies of the same treatment. This report summarizes the work carried out by the Vitiligo European Task Force to propose a consensus definition of the disease and to assess treatment outcomes using a system which combines analysis of extent, stage of disease (staging), and disease progression (spreading). In summary, extent is evaluated using the rule of 9. Staging is based on cutaneous and hair pigmentation in vitiligo patches, and the disease is staged 0-3 (revised version) on the largest macule in each body region, except hands and feet, which are assessed separately and globally as one unique area. Assessment of spreading is based on Wood's lamp examination of the same largest macule in each body area. Wood's lamp is useful for a combined assessment of staging and spreading in the same selected area. This study reports a workshop which validated the clinical use of the assessment form performed at several European University clinics, and showed an overall good concordance among panelists using the proposed scoring system. This system can be easily handled in clinical practice. However, variations between scorer profiles indicate a need for training to decrease interobserver variability. Further steps are envisaged, namely: (i) build a global index including staging and spreading for the initial assessment of vitiligo patients, usable as a guidance for therapeutic indications and prognosis, which could be interpreted as an equivalent of the TNM (tumor, node, metastasis) system for cancer; (ii) implement large-scale tests necessary for clinical trials (to check reproducibility and sensitivity); (iii) carry out studies of automated devices to assess extent more accurately; (iv) set up a teaching tool for scoring vitiligo, which could be posted on a website; and (v) set up an international conference on classifying, staging and scoring vitiligo, through the IFPCS Special Interest Group on Vitiligo.