Clinical Prognostic Factors Predicting Outcomes in Vitiligo: A Scoping Review

Abstract

The progression of non-segmental vitiligo is highly unpredictable, exhibiting various phenotypes that can range from rapid progression to stability. Due to limited literature, we conducted a scoping review to identify factors influencing the outcomes of non-segmental vitiligo, focusing on disease progression, extent, and response to therapy. This review adhered to PRISMA-ScR guidelines and involved searching the PubMed and Google Scholar databases for studies published in English from January 1995 to December 2023. We included observational, retrospective, case-control, and cohort studies while excluding case reports, systematic reviews, meta-analyses, and studies on segmental vitiligo. Out of 922 records identified, 819 were screened, resulting in 792 exclusions based on titles or abstracts. Ultimately, 22 articles were selected for review after evaluating the full texts of 27 articles. Several factors were consistently linked to poorer prognoses in multiple studies: family history of vitiligo, mucosal involvement, Koebnerization, and the presence of adverse clinical markers. Age of onset yielded conflicting results regarding disease progression but showed general agreement concerning the extent of involvement. Specific lesions such as confetti-like lesions were also associated with progression in limited studies. Additionally, longer disease duration, leukotrichia, and mucosal involvement correlated with a greater body surface area affected by vitiligo, often resulting in poor repigmentation responses to medical treatments. Patients exhibiting poor prognostic markers-such as family history, mucosal lesions, or Koebnerization-should be advised to monitor for new lesions closely and consider early treatment initiation. Understanding the factors influencing the course of non-segmental vitiligo's course can guide clinicians in tailoring management strategies that reflect individual patient needs while considering the complexities associated with this condition. A prospective study with at least 1 year of follow-up is needed to comprehensively describe observed progression, along with well-defined predictors and outcome measures including temporal course patterns. Prospero Registration: CRD42023446544.

Keywords: Koebnerization; prognosis; progression in vitiligo; repigmentation; vitiligo.