Depigmentation patterns of nonsegmental vitiligo: a prospective study of macromorphologic changes in lesions

Efforts have been recently made to investigate simple, objective, accurate, and reproducible methods of clinical/noninvasive assessment of nonsegmental vitiligo. However, studies have mostly considered quantitative or semiquantitative parameters, almost neglecting the purely qualitative appearance of vitiligo lesions at a given moment and over time.

The objective of this study was to investigate the dynamics of macromorphologic alterations taking place within vitiligo patches.

This was a prospective study of a vitiligo cohort.

Consecutive patients affected by nonsegmental vitiligo.

Enrolled patients affected by nonsegmental vitiligo underwent a dermatology visit once monthly for 12 months. Vitiligo lesions were photographed at each visit under both room light and Wood's light, and analyzed via a morphometric, digitalized software capable of detecting quantitative changes of white areas. Pictures depicting changing patches were evaluated in order to assess clinical morphology.

Ninety patients were included for the final analysis and 360 lesions were evaluated, 102 of which (28.9 %) showed changes of white areas. Subjective evaluation highlighted two distinct depigmentation patterns, which were present either alone or in combination: (1) a sharply defined band of intermediate color between the depigmented center and the surrounding normal skin, which was defined as 'marginal hypopigmentation;' and (2) pinpoint hypopigmented/depigmented macules centered by a follicle, which we named 'perifollicular depigmentation.' On the other hand, only one repigmentation pattern was detected, the already known 'perifollicular repigmentation.'

The depigmentation process in vitiligo seems to follow only two specific patterns. This preliminary study represents, in our opinion, a valuable background for future research aiming to investigate the dynamics of vitiligo pathogenesis or assess depigmentation/repigmentation patterns for monitoring treatment response.