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

G. Menchini, C. Comacchimentation, the value to be assigned to thearea is -1 (minus 1).3) If the area presents no noticeable signs ofimprovement nor signs of worsening butonly stationary patches, the value to beassigned to the area is 0 (zero).At the end of this stage, every area should havea value, adding the singular values of every areawe obtain another value, called Vitiligo ActivityScore (VAS), varying from -8 to 24.Negative VAS values indicate an improvement,while positive ones indicate a worsening ofVVB.The ratio between VAS and VAA is the VitiligoActivity Index value (VAI), between -1 and 3,VAI can give us the same information as VASnot taking into account the affected skin surface(Figure 8).C onclusionsVitiligo therapy has always been oneof the major critical point for dermatology, andwe believe one of the causes of this situation isthe lack of a clinical score that can evaluate thedisease’s aggressiveness or the treatment reaction.The evaluation system currently in use in thefield, which is based on the measuring of thesurface of patches through photographical data,is extremely complex and represents a very littleaid to dermatologists.Identification of clinical signs of vitiligo worseningor improvement constitutes a majorprogress in VVB research and treatment; it alsomeans that we can formulate a precise activityindex.VAI, being a description of VVB activity levelbased upon morphological variations of patches,represents a major benefit in many regards:for dermatologists VAI represents an active aidin therapy and treatment choice, for instance aworsening case of vitiligo re q u i res a moreimmunosuppressant kind of therapy rather thatone of repigmentation.Furthermore, VAI makes follow-up easier andquicker since in a few minutes dermatologistscan evaluate the subject’s state of improvementor worsening and therefore calibrate the therapyaccordingly.VAI also represents a fundamental tool for comparingdiff e rent therapeutical protocols, inorder to formulate an ideal therapy.Figure 7. Skin surface mapping for VAI calculation. VAI calculation form.VAI= VAS/VAAVitiligo Activity Index = Vitiligo Activity Score / Vitiligo Affected AreasImprovementStableWorsening-1 0 1 2 3Figure 8. Vitiligo Activity Index formula. Vitiligo isproportionally worsening when VAI value is higher than 0,while the patient is improving when VAI value is below 0.We used VAI in our daily clinical practice andwe noted a direct relation between VVB activitydegree and VAI value, yet we need specific scientificproofs in order to verify our observationsand present them to the whole scientific communityof field researches.38Journal of Plastic Dermatology 2007; 3, 3