Reliability, Validity and Feasibility of the Vitiligo Extent Score (VES) and Self-Assessment Vitiligo Extent Score (SA-VES) Among Vitiligo Patients: A Cross-Cultural Validation

Figures & data

Table 1 Demographic and Clinical Characteristics of 100 Vitiligo Patients

Characteristics	All Vitiligo Patients	BSA%
		<1%	1–9.99%	≥10%
Number of patients	100	56	32	12
Gender, n (%)
Male	23 (23.0%)	13 (23.2%)	8 (25.0%)	2 (16.7%)
Female	77 (77.0%)	43 (76.8%)	24 (75.0%)	10 (83.3%)
Age (yrs), median (IQR)	42 (32.3–55)	39.5 (31–53)	39 (18–73)	50 (45.8, 63.8)
Photo skin type, n (%)
III	25 (25.0%)	17 (30.4%)	6 (18.8%)	2 (16.7%)
IV	59 (59.0%)	34 (60.7%)	18 (56.3%)	7 (58.3%)
V	16 (16.0%)	5 (8.9%)	8 (25.0%)	3 (25.0%)
Age of onset (yrs), median (IQR)	34.5 (24.5–49.3)	35 (23–49)	32 (25–54)	33.5 (17.8–54)
Disease duration (yrs), median (IQR)	3 (1–10)	2 (0.7–5.8)	6.5 (3–10)	7 (1.1–29)
Type of vitiligo, n (%)
Segmental	15 (15.0%)	10 (17.9%)	4 (12.5%)	1 (8.3%)
Unisegmental	13 (13.0%)	9 (16.1%)	3 (9.4%)	1 (8.3%)
Bisegmental	2 (2.0%)	1 (1.8%)	1 (3.1%)	0 (0.0%)
Non-segmental	80 (80.0%)	41 (73.2%)	28 (87.5%)	11 (91.7%)
Generalized	67 (67.0%)	30 (53.6%)	26 (81.3%)	11 (91.7%)
Acrofacial	13 (13.0%)	11 (19.6%)	2 (6.3%)	0 (0.0%)
Unisegmental	5 (5.0%)	5 (8.9%)	0 (0.0%)	0 (0.0%)
BSA% (based on VES), median (IQR)	0.89 (0.44–3.02)	0.48 (0.25–0.74)	2.49 (1.49–6.88)	18.29 (11.89–26.13)
Area of involvement, n (%)
Face	53 (53.0%)	28 (50.0%)	18 (56.3%)	7 (58.3%)
Trunk	49 (49.0%)	18 (32.1%)	21 (65.6%)	10 (83.3%)
Extremities	51 (51.0%)	20 (35.7%)	20 (62.5%)	11 (91.7%)
Feet	53 (53.0%)	18 (32.1%)	26 (81.3%)	9 (75.0%)
Hand	63 (63.0%)	28 (50.0%)	25 (78.1%)	10 (83.3%)
Poliosis, n (%)	24 (24.0%)	16 (28.6%)	5 (15.6%)	3 (25.0%)
Active disease	44 (44.0%)	24 (42.9%)	14 (43.8%)	6 (50.0%)
Confetti depigmentation	5 (5.0%)	4 (7.1%)	1 (3.1%)	0 (0.0%)
Trichome lesion	1 (1.0%)	0 (0.0%)	1 (3.1%)	0 (0.0%)
Köebner phenomenon	1 (1.0%)	0 (0.0%)	1 (3.1%)	0 (0.0%)
Inflammatory vitiligo	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
New lesion within 3 months	41 (41.0%)	21 (37.5%)	14 (43.8%)	6 (50.0%)
Associated diseases	14 (14.0%)	8 (14.3%)	6 (18.8%)	0 (0.0%)
Family history of vitiligo	24 (24.0%)	11 (19.6%)	9 (28.1%)	4 (33.3%)

Abbreviations: BSA, body surface area; IQR, interquartile range; VES, Vitiligo Extent Score.

Table 2 Inter-Rater Correlation of VES and VASI According to Lesion Location, BSA%, Type of Vitiligo, and Disease Status

	VES		VASI
	ICC (95% CI)	SDC95	ICC (95% CI)	SDC95
Location of lesions
All locations	0.997 (0.995–0.998)	2.71	0.988 (0.982–0.992)	5.18
Face	0.887 (0.837–0.923)	0.81	–	–
Trunk	0.990 (0.986–0.994)	2.89	–	–
Extremities	0.988 (0.982–0.992)	2.49	–	–
Feet	0.913 (0.873–0.941)	0.94	–	–
Hands	0.910 (0.868–0.938)	0.43	–	–
BSA%
<1%	0.848 (0.754–0.908)	0.62	0.820 (0.711–0.890)	0.78
1–9.99%	0.961 (0.922–0.981)	3.19	0.932 (0.865–0.966)	4.34
≥10%	0.995 (0.981–0.998)	5.95	0.971 (0.903–0.992)	13.03
Type of vitiligo
Segmental	0.992 (0.976–0.997)	1.39	0.985 (0.957–0.995)	2.01
Non-segmental	0.997 (0.995–0.998)	2.96	0.988 (0.981–0.992)	5.65
Focal	0.772 (0.106–0.974)	0.55	0.742 (0.174–0.970)	0.48
Disease status
Stable	0.996 (0.993–0.997)	2.60	0.994 (0.989–0.996)	2.73
Active	0.997 (0.995–0.999)	3.23	0.986 (0.974–0.992)	7.04

Abbreviations: BSA, body surface area; CI, confidence interval; ICC, intraclass correlation coefficient; SDC, smallest detectable change; VASI, Vitiligo Area Scoring Index; VES, Vitiligo Extent Score.

Figure 1 Correlation analysis between (A) the VASI and VES, (B) the VES and SA-VES, and (C) the VASI and SA-VES.

Figure 2 Bland-Altman analyses for agreement between (A) the VES and VASI, (B) the VES and SA-VES, and (C) the VASI and SA-VES.

Table 3 Spearman Correlation Analysis Between Different Instrument Combinations Relative to Location of Lesions, BSA%, Type of Vitiligo, and Disease Stability

	VES vs VASI		VASI vs SA-VES		VES vs SA-VES
	r	p-value	r	p-value	r	p-value
Location of lesions
All locations	0.976 (0.964–0.984)	<0.001	0.866 (0.807–0.908)	<0.001	0.890 (0.840–0.925)	<0.001
Face	–	–	–	–	0.587 (0.441–0.702)	<0.001
Trunk	–	–	–	–	0.919 (0.822–0.945)	<0.001
Extremities	–	–	–	–	0.858 (0.795–0.902)	<0.001
Feet	–	–	–	–	0.907 (0.865–0.937)	<0.001
Hands	–	–	–	–	0.872 (0.815–0.912)	<0.001
BSA%
<1%	0.892 (0.822–0.936)	<0.001	0.537 (0.319–0.701)	<0.001	0.584 (0.379–0.734)	<0.001
1–9.99%	0.898 (0.800–0.949)	<0.001	0.790 (0.610–0.893)	<0.001	0.942 (0.884–0.972)	<0.001
≥10%	0.923 (0.743–0.979)	<0.001	0.937 (0.786–0.983)	<0.001	0.986 (0.949–0.996)	<0.001
Type of vitiligo
Segmental	0.831 (0.555–0.942)	<0.001	0.649 (0.204–0.871)	<0.001	0.671 (0.124–0.850)	<0.001
Non-segmental	0.970 (0.953–0.980)	<0.001	0.846 (0.769–0.899)	<0.001	0.883 (0.823–0.924)	<0.001
Focal	0.900 (0.086–0.993)	0.037	0.205 (−0.827–0.921)	0.741	0.051 (−0.893–0.870)	0.935
Disease status
Stable	0.977 (0.962–0.987)	<0.001	0.869 (0.786–0.922)	<0.001	0.865 (0.779–0.919)	<0.001
Active	0.958 (0.924–0.977)	<0.001	0.826 (0.701–0.902)	<0.001	0.885 (0.798–0.936)	<0.001

Note: A p-value<0.05 indicates statistical significance.

Abbreviations: BSA, body surface area; SA-VES, Self-Assessment Vitiligo Extent Score; VASI, Vitiligo Area Scoring Index; VES, Vitiligo Extent Score.