Development and pilot testing of a vitiligo screening tool

Studies aimed at understanding the pathology, genetics, and therapeutic response of vitiligo rely on asking a single question about 'physician-diagnosed' vitiligo on surveys to identify subjects for research. However, this type of self-reporting is not sufficient. Our objective was to determine if the patient-administered Vitiligo Screening Tool (VISTO) is a sensitive and specific instrument for the detection of vitiligo in an adult population. The VISTO consists of eight closed-ended questions to assess whether the survey participant has ever been diagnosed with vitiligo by a healthcare worker and uses characteristic pictures and descriptions to inquire about the subtype and extent of any skin lesions. 159 patients at the Brigham and Women's Hospital dermatology clinic with or without a diagnosis of vitiligo were recruited. A board-certified dermatologist confirmed or excluded the diagnosis of vitiligo in each subject. 147 completed questionnaires were analyzed, 47 cases and 100 controls. The pictorial question showed 97.9% sensitivity and 98% specificity for diagnosis of vitiligo. Answering "yes" to being diagnosed with vitiligo by a dermatologist and choosing one photographic representation of vitiligo showed 95.2% sensitivity and 100% specificity for diagnosis of vitiligo. We conclude that VISTO is a highly sensitive and specific, low-burden, self-administered tool for identifying vitiligo among adult English speakers. We believe this tool will provide a simple, cost-effective way to confirm vitiligo prior to enrollment in clinical trials as well as for gathering large-scale epidemiologic data in remote populations. Future work to refine the VISTO is needed prior to use in genotype-phenotype correlation studies.