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

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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
Vitiligo Activity Index, a new activity evaluation index for bilateral vitiligo vulgarisR eferences1. Rezaei N, Gavalas NG, Weetman AP, KempEH. Autoimmunity as an aetiological factor in vitiligo. J EurAcad Dermatol Venereol 2007; 21:865-762. Ram M, Shoenfeld Y. Harnessing autoimmunity (vitiligo)to treat melanoma: a myth or reality? Ann N Y Acad Sci2007; 1110:410-253. Uchi H, Stan R, Turk MJ, Engelhorn ME, Rizzuto GA,Goldberg SM, Wolchok JD, Houghton AN. Unraveling thecomplex relationship between cancer immunity andautoimmunity: lessons from melanoma and vitiligo. AdvImmunol 2006; 90:215-414. Passeron T, Ortonne JP. Physiopathology and genetics ofvitiligo. J Autoimmun 2005; 25 Suppl:63-8. Epub 2005Nov 185. Garbelli S, Mantovani S, Palermo B, Giachino C.Melanocyte-specific, cytotoxic T cell responses in vitiligo:the effective variant of melanoma immunity? Pigment CellRes 2005; 18:234-426. Sehgal VN, Srivastava G.Vitiligo treatment options: anevolving scenario. J Dermatolog Treat 2006; 17:262-757. Westerhof W, d'Ischia M. Vitiligo puzzle: the pieces fall inplace. Pigment Cell Res 2007; 20:345-598. Hann SK, Kim YS, Yoo JH, Chun YS. Clinical andhistopathologic characteristics of trichrome vitiligo. J AmAcad Dermatol 2000; 42:589-969. Zannolli R, Buoni S, Macucci F, Scarinci R, Viviano M, OrsiA, de Aloe G, Fimiani M, Vo l t e rrani L, de Santi MM, MiraccoC, Zappella M, Hayek J. Kabuki syndrome with trichro m evitiligo, ectodermal defect and hypogammaglobulinemia Aand G. Brain Dev 2007; 29:373-6. Epub 2006 Dec 1410. Sehgal VN, Srivastava G. Vitiligo: compendium of clinico-epidemiologicalfeatures. Indian J Dermatol VenereolLeprol 2007; 73:149-56Journal of Plastic Dermatology 2007; 3, 339
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Page 4: L’istopatologia ed il foto-invecc
Page 10: P. Filecciaammesso nelle formulazio
Page 13 and 14: A. Sparavigna A, R. Forte, F.S. Dio
Page 20 and 21: M. Cavallini, M. Papagnitaining lon
Page 22 and 23: M. Cavallini, M. PapagniSkin hydrat
Page 24 and 25: M. Cavallini, M. Papagni5. Altman D
Page 26 and 27: G. Menchini, C. ComacchiM ethodsO b
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Page 42 and 43: D. AnconaGli studi sulla citotossic
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struzioni agli AutoriIObiettivo del
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