A New Assessment Method of Vitiligo by Combination of Dermoscopy and Reflectance Confocal Microscopy

Figures & data

Figure 1 Dermoscopic features of patients with vitiligo. (a) Absent pigment network and sharp border (polarized light ×20); (b) faint pigment network (polarized light ×20); (c) perifollicular hyperpigmentation (yellow arrow, polarized light ×50); (d) perifollicular depigmentation (blue arrow, polarized light ×50); (e) micro-Koebner phenomenon (green arrow, polarized light ×20); (f) satellite phenomenon (black arrow, polarized light ×20).

Figure 2 RCM features of patients with vitiligo. (a) Existence pigment rings in the basal layer of the lesion; (b) absence pigment rings in the basal layer of the lesion; (c) clear border (the red line shows the demarcation.); (d) ill-defined border; (e) inflammatory cell infiltration (yellow arrow); (f) dendritic melanocytes (blue arrow).

Table 1 Comparison of Vitiligo Activity by Different Skin Imaging Techniques [Cases (%)]

	VIDA Score	Dermoscopic Score*		RCM Score**		Dermoscope Combined with RCM Score***
		Active Stage	Stable Stage	Active Stage	Stable Stage	Active Stage	Stable Stage
Active stage	225	210 (75.27)	15 (5.38)	204 (73.12)	21 (7.52)	219 (78.49)	6 (2.15)
Stable stage	54	24 (8.60)	30 (10.75)	22 (7.89)	32 (11.47)	13 (4.66)	41 (14.70)
Total	279	234	45	226	53	232	47
Sensitivity	–	93.33		90.67		97.33
Specificity	–	55.56		59.26		75.93
Pseudopositive rate	–	44.44		40.74		24.07
Pseudonegative rate	–	6.67		9.33		2.67

Notes: *P = 0.200, Kappa = 0.522; **P = 1.000, Kappa = 0.503, ***P = 0.167, Kappa = 0.771. P value <0.05 is considered statistically significant.

Abbreviations: RCM, reflectance confocal microscopy; VIDA score, Vitiligo Disease Activity Score.

Table 2 Dermoscopic and RCM Features in Vitiligo Patients with Different Effect Response (Cases).

Category		Effective Cases	Ineffectual Cases	χ2 value	P-value
Number of cases		46	46
Dermoscopic features	Increased pigment around hair follicles	28	18	4.348	0.037*
	Border clarity	16	11	0.311	0.252
	Border blurring	8	3	2.581	0.108
	White hair restoration	11	7	1.105	0.293
	Increased pigment at the lesion	46	22	32.471	0.000*
	Telangiectasia	25	15	4.423	0.035*
RCM features	Dendritic cells	27	16	5.283	0.022*
	Increased pigment granules	46	19	38.215	0.000*

Notes: *Represents the P value is less than 0.05. P value <0.05 is considered statistically significant.

Table 3 Comparison of Baseline Characteristics of Dermoscopy and RCM in Vitiligo Patients with Different Treatment Effects (Cases).

Category		Effective Cases	Ineffectual Cases	χ2 value	P-value
Number of cases		46	46
Dermoscopic features	Perifollicular depigmentation	36	32	0.902	0.342
	Perifollicular hyperpigmentation	34	23	5.580	0.018*
	Perilesional hyperpigmentation	0	6	-	0.026*
	Telangiectasia	26	21	1.087	0.297
	Leukotrichia	26	35	3.941	0.047*
	Pigment network absent	1	7	4.929	0.026*
	Micro-Koebner phenomenon	0	5	-	0.056
	Satellite phenomenon	15	16	0.049	0.825
	Clear border	11	14	0.494	0.482
RCM features	Pigment ring absence	6	14	4.089	0.043*
	Pigment ring existence	40	32	4.089	0.043*
	Clear border	5	6	0.103	0.748
	Ill-defined border	41	40	0.103	0.748
	Inflammatory cell infiltration	32	32	0.000	1.000
	Dendritic melanocytes	2	5	-	0.434

Notes: *represents the P value is less than 0.05. P value <0.05 is considered statistically significant.

Figure 3 Dermoscopic and RCM changes in the process of treatment. (a) Dermoscopic observation showing increased pigment at the lesion (green arrow), white hair restoration (black arrow) and telangiectasia (blue arrow, polarized light ×50); (b) increased pigment around the hair follicle (blue arrow), white hair restoration (black arrow, polarized light ×20); (c) RCM observation of the repigmentation process showed dendritic melanocytes (yellow arrow); (d) starburst-like dendritic melanocytes (yellow arrow); (e) the pigment rings increased in the basal layer and were bent into a “mitochondrial crista-like” structure (green arrow); (f) Increase of pigment granules in the basal layer (green arrow).