Development and pilot testing of a vitiligo screening tool

Abstract

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.

A New Biomarker in Patients with Vitiligo: A Case-Control Study

“…The segmental types has asymmetrical dermatological pattern accompanied by autoimmune diseases. In the universal type, hypopigmentation is seen in all body surfaces [2,4]. In most patients, the depigmentation begins in areas exposed to sunlight [2].…”

“…Although its cause is unknown, several theories have been presented such as autoimmunity, autocytotoxicity, oxidative stress and neurohormonal complications [2][3][4], the most common of which is autoimmunity with a genetic background [3]. Vitiligo often begins in childhood or young adulthood [2]. Almost half of the affected individual sure initially afflicted before the age of 20 and its prevalence decreases with age.…”

“…The destruction of melanocytes is the result of depigmented macules clinically seen in this disease. Although its cause is unknown, several theories have been presented such as autoimmunity, autocytotoxicity, oxidative stress and neurohormonal complications [2][3][4], the most common of which is autoimmunity with a genetic background [3]. Vitiligo often begins in childhood or young adulthood [2].…”

“…Vililigo is classified based on the extent of involvement and the distribution of depigmentation [2]. The most common manifestation of vitiligo is the generalized type in the form of bilateral symmetrical depigmentations on the face, neck, extensor surfaces or bony surfaces on the hands, feet, wrists, axilla and mucosal surfaces [1,3].…”

“…Almost half of the affected individual sure initially afflicted before the age of 20 and its prevalence decreases with age. Its global prevalence has been estimated to be 1-2% [2,4]. It equally affects men and women and there is no association between skin type and vitiligo [3].…”