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Focal vitiligo: long-term follow-up of 52 cases
J E Lommerts1, Y Schilder1, M A de Rie1,2
1Department of Dermatology, Netherlands Institute for Pigment Disorders (NIPD), Academic Medical Centre (AMC), Amsterdam, The Netherlands.
Background:
Focal vitiligo is characterized by depigmented patches located in a small area without a typical segmental distribution. Focal vitiligo is classified as an undetermined type of vitiligo, and a more definitive diagnosis can be made when the lesions have not evolved into non-segmental or segmental vitiligo after a period of 1-2 years. However, the chance of progression is not known and may lead to treatment-indecision.
Objective:
The objective was to study the characteristics of patients with focal vitiligo and possible predictors of progression.
Methods:
We conducted a survey study in patients with initial diagnosis of focal vitiligo between January 2005 and June 2010. Focal vitiligo was defined as either a small acquired isolated depigmented lesion without typical segmental distribution, or two to three small acquired lesions localized in a non-segmental area with a maximum of 5 cm. The survey comprised of 21 questions concerning the patient's characteristics, the onset of focal vitiligo, progression of depigmentation and treatment history.
Results:
We identified 128 eligible patients and the response rate was 40.6% (n = 52 completed questionnaires). Progression to non-segmental vitiligo occurred in 23%. The median follow-up duration was 7 years. In 11.5% of the patients, progression to non-segmental vitiligo occurred within 2 years after onset. Nevertheless, even after a first stable period of more than 2 years, another 11.5% of the patients advanced to non-segmental vitiligo. No associated prognostic factors at baseline of progression to non-segmental or long-lasting focal vitiligo were found.
Conclusion:
Focal vitiligo is a rare subtype of vitiligo and most patients have long-lasting focal lesions after onset of the disease. In this study, focal vitiligo progressed to typical non-segmental vitiligo, but not towards typical segmental vitiligo. Progression 2 years after onset of focal vitiligo, occurs in 50% of the patients with eventual progression to non-segmental vitiligo. There seem to be no clinical signs that predict progression in focal vitiligo.
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