Dicembre Vol.3 N° 3 - 2007 - Salute per tutti

Vitiligo Activity Index, a new activityevaluation index for bilateralvitiligo vulgarisGiovanni MenchiniClaudio ComacchiSU M M A R YVitiligo Activity Index,a new activity evaluation indexfor bilateral vitiligo vulgarisVitiligo vulgaris is an autoimmune disease with fairly unpredictable clinicalprogress. The population incidence worldwide is 1% without significant associationswith race or sex. To this day no prognostic index exists and no standard symptomaticreference scheme has been established to evaluate the clinical course of the disease,in order to point dermatologists toward an appropriate therapeutic path and to guideresearchers approaching new treatments.In this paper we present a new evaluation index called Vitiligo Activity Index, aneasy tool that enables dermatologists to relate the disease activity to a precisenumerical value.KE Y W O R D S: Vitiligo Activity Index, Vi t i l i g oG.I.S.V.(Gruppo Italiano di Studio e Terapiadella Vitiligine), Pisa e Firenze, ItaliaI ntroductionVitiligo Vulgaris Bilateral (VVB) is adisease that causes the formation of ipochromic/achromicpatches of skin and its pathogenesisis almost certainly autoimmune (1-5).Conventional therapy consists mainly ofimmunosuppressant and ultraviolet B narrowband phototherapy (6).Similarly to other autoimmune diseases, VVBclinical course is extremely variable, alternatingperiods of progression, stationary states and afew spontaneous events of repigmentation (7).To this day, VVB course evaluation was almostexclusively based upon the patient’s own observationand on the description of the patient’simpressions to the dermatologist.One of the major causes of therapeutic failure isthe lack of prognostic indexes and lab-baseddata that describe the actual activity conditionof VVB.In order to make up for this deficiency, weidentified morphological skin signs that arepathognomonic of a recent disappearing ofmelanocytes or of recent re p i g m e n t a t i o n .Some of the morphological signs identified inthis study have already been described in otherscientific papers (such as follicle repigmentation);other signs are described for the first timein this article.An exhaustive study of morphology in vitiligopatches led us to the conclusion that they areactually interrelated with vitiligo activity andprogress.On the basis of our observation data, derivedfrom a ten year long experience in vitiligoresearch and therapy, we suggest the introductionof an index called Vitiligo Activity Index(VAI), in order to quantify and describe thelevel and nature of activity of the disease.In our opinion, VAI quantifies the diseaseaggressiveness or repigmentation and thereforeallows a more appropriate therapy choice and arapid evaluation of the therapy progress.Our goal is the creation of an index that can beeasily consulted and understood by patientsand doctors alike and that can lead to a quickevaluation of the subject’s dermatosis.Journal of Plastic Dermatology 2007; 3, 3 35