A prospective observational study of the dermoscopic findings of nonsegmental vitiligo in different stages of evolution

Abstract

Background: Dermoscopy has rapidly gained ground as a tool to assess vitiligo activity. However, a methodical approach to assessing dermoscopy in vitiligo and evaluating its role in predicting outcomes is still evolving.

Objectives: To compare dermoscopic findings of individual vitiligo lesions in different stages of evolution and to evaluate the utility of dermoscopy to predict the outcome at follow-up.

Methods: In total, 68 patients with nonsegmental vitiligo were recruited, with a total of 171 lesions. Lesions were classified as stable, progressive or repigmenting based on history and/or clinical photography. In total, 101 lesions in 40 patients were followed up at 3 months. The lesions were reclassified based on photographic comparison with baseline images. The dermoscopic findings included the type and distribution of pigment network, margin definition, perifollicular and perilesional pigmentation, leucotrichia and discernibility of eccrine openings.

Results: Most stable lesions showed complete absence of pigment network at both baseline (52 of 56, 93%) and follow-up (38 of 47, 81%). Progressive lesions showed variability in both the type and distribution of pigment, along with ill-defined margins (34 of 68, 50%) and perilesional hypopigmentation (27 of 68, 40%). Micro-koebnerization, perilesional white globules, peppering of pigment at the periphery of the lesion, and loss of pigment in a linear pattern in the periphery were specific for progressive disease. Repigmenting lesions demonstrated perilesional (38%) and perifollicular hyperpigmentation (77%). Well-defined margins and perilesional hyperpigmentation at baseline were associated with lesions remaining stable, whereas lesions with focal or diffuse reduction of pigment and perilesional hypopigmentation and/or white globules were more likely to progress.

Conclusions: Dermoscopy is useful in determining disease activity and has potential utility in assessing the outcome of vitiligo lesions in a large proportion of cases.