Background NB‐UVB has long been the vitiligo management pillar with capability of achieving the main treatment outcomes; repigmentation and stabilization. Its stabilizing effect in dark skin has been debatable. However, randomized controlled trials regarding NB‐UVB ability to control disease activity are lacking. Purpose To assess stabilizing effect of NB‐UVB in comparison to systemic corticosteroids, the mainstay in vitiligo stabilization, in skin photo‐types (III‐V). Methods This is a multicenter, placebo‐controlled, randomized, prospective study. Eighty patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either NB‐UVB and placebo (NB‐placebo) or NB‐UVB and dexamethasone oral mini‐pulse (OMP) therapy (NB‐OMP) for 6 months. Sixty four patients completed the study, 34 in the NB‐OMP group and 30 in the NB‐placebo group. Patients were evaluated fortnightly according to presence or absence of symptoms/signs of activity. Results In spite of earlier control of disease activity observed in the NB‐OMP group, it was comparable in both groups by the end of the study period. Disease activity prior to therapy, but not extent, was found to influence control of activity in both groups. Thus, NB‐UVB is a safe sole therapeutic tool in vitiligo management. Not only does it efficiently achieve repigmentation, but also it is a comparable stabilizing tool for systemic corticosteroids in spite of slightly delayed control. Conclusion NB‐UVB is the only well‐established vitiligo therapy that can be used solely whenever corticosteroids are contraindicated or immune‐suppression is unjustified. Nonetheless, its combination with corticosteroids expedites response and improves compliance.

Background Vitiligo Area and Severity Index (VASI) is standing on the top of the cited and implemented scoring tools for vitiligo. However, an easily applicable and time‐saving tool has been a need. Aim This cross‐sectional study aimed at comparing the body surface area (BSA) calculation method used in Vitiligo Extent Score (VES) in comparison with the hand unit method used in VASI and to consider the implementation of VES as a user‐friendly tool by doctors as applied to observed clinical patterns of NSV in our population. Methods For each patient with NSV, vitiligo was assessed using both VES and VASI as well as vitiligo disease extent by hand units. Results Vitiligo extent score and VASI scores showed a strong significant correlation. Both scores were found reliable in spite of the presence of unrepresented areas in the VES with tendency of the values for the BSA by the VES to be lower than that by hand units. Conclusion In comparison with VASI, VES has proven to be a clear, user‐friendly score for vitiligo assessment. However, special concern is to be given for required modification for pediatric population. A slight modification may be required regarding the pediatric population.

In spite of multiple therapeutic regimens for vitiligo, disease relapse remains a challenge. Most guidelines consider systemic treatments only in rapidly progressive disease with wider surface areas. This delay in halting the immune attack, may give the chance for further disease progression as well as establishment of resident memory T‐cell population predisposing to future relapses. To assess the ability of early systemic therapy of localized (<2% BSA), recent onset (<6 months) vitiligo to control disease activity and minimize the possibility of recurrence. Twenty‐five patients with recent onset (<6 months), localized (<2% BSA) vitiligo were included. Patients received pulse dexamethasone therapy for 6 months plus topical treatments and NB‐UVB sessions. Patients were followed monthly as regards percent of repigmentation and VIDA score. To detect recurrence, biannual assessment was done for 4 years. Eighty‐four percent of patients had acrofacial lesions and 44% had facial lesions. Arrest of activity was achieved after 3.65 ± 2.19 months. Complete repigmentation was achieved in a mean duration of 6.88 ± 0.2 months. At the end of the 4‐year follow up, recurrence occurred in 32% of patients. In spite of recurrence, localized disease (<2% BSA) was secured. A significantly higher incidence of recurrence was associated with cases with bilateral distribution of lesions. Early systemic immunomodulation for recent localized vitiligo is a successful approach to achieve early control of disease activity and minimize the incidence of recurrence. Such cases should not be overlooked but managed as early as possible; it is a race against time.

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Dear Editor, Narrow-band ultraviolet B (NB-UVB) is a widely used treatment for non-segmental vitiligo (NSV). It is frequently combined with topical therapy (such as calcineurin inhibitors and/or corticosteroids), due to the superiority of combination therapy above monotherapy. [1][2][3][4] In cases of rapidly spreading vitiligo, systemic steroids in an oral minipulse (OMP) scheme are often added to this therapy to arrest

Background Autoimmune and metabolic disturbances have been reported in association with vitiligo, highlighting possible systemic associations that should be considered. Aims To assess the possible association of metabolic syndrome (MetS) as well as insulin resistance (IR) with vitiligo in different age groups. Methods This case–control study included 142 patients with vitiligo aging ≥ 6 years and 142 age‐ and sex‐matched controls. Participants were assessed for MetS using the International Diabetes Federation (IDF) criteria in addition to IR via homeostasis model assessment of IR (HOMA‐IR). The study was registered at Clinical http://trials.gov, Identifier: NCT03622320, on August 9, 2018. Results As per the IDF criteria, patients with vitiligo showed significantly more frequent association with high fasting plasma glucose levels, high blood pressure readings, central obesity, dyslipidemia, and MetS than controls (p = 0.020, p = 0.034, p = 0.014, p < 0.001, and p = 0.002, respectively). Moreover, patients with vitiligo have significantly higher levels of fasting insulin and HOMA‐IR (p ≤ 0.001). Results obtained from patients with vitiligo and controls with coexistent MetS/IR demonstrated vitiligo as a risk factor for both MetS and IR. Univariate and multivariate logistic regression highlighted that older age was the significant independent predictor for MetS and IR. Conclusion Patients with vitiligo showed a significantly higher incidence of MetS than controls. Vitiligo per se can be considered a risk factor for MetS and IR. Therefore, regular follow‐up and early metabolic derangement diagnoses are mandatory.

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Vitiligo is no longer a pure cutaneous disorder. The association with other autoimmune diseases such as thyroid disorders and type I diabetes mellitus "DM" has drawn attention to the systemic nature of vitiligo. 1,2 Vitiligo patients showed higher incidence of insulin resistance "IR" 3 and metabolic syndrome "MetS" 4,5 as well increased cardiovascular risk 6 when compared to healthy controls, supporting the systemic nature of vitiligo.Relation between vitiligo and the aforementioned metabolic derangements can partly be explicated by the presence of melanocytes in the adipose tissue milieu. [6][7][8][9][10] This sheds light on melanocyteadipocyte cross-talk suggesting potential multi-factorial role of leptin in vitiligo pathogenesis.