Comparative analysis of the body surface area calculation method used in vitiligo extent score vs the hand unit method used in vitiligo area severity index

Mogawer, Rania M.; Mostafa, Wedad Z.; Elmasry, Maha Fathy

doi:10.1111/jocd.13311

Cited by 7 publications

(7 citation statements)

References 20 publications

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“…Evaluating disease severity is beneficial to stratifying patients and monitoring treatment response. It can be rated by clinician-reported methods where higher grades correspond to more severe disorder [77][78][79]: body surface area (BSA, the percentage of lesions affected), Vitiligo Area Scoring Index (VASI, BSA*residual depigmentation, ranging from 0 to 100), newly developed Vitiligo Extent Score (VES, 0-6 degree of the affection extent), and Vitiligo Disease Activity (VIDA) scores (− 1 to 4 point scale). In parallel, self-assessment tools have also been introduced including Self Assessment Vitiligo Extent Score (SA-VES) e Trichrome lesions (black arrows) and poorly defined borders (white arrows) [80,81] and Self Assessed Vitiligo Area Scoring Index (SA-VASI) [82].…”

Section: Diagnosis Differential Diagnosis and Disease Assessmentmentioning

confidence: 99%

“…Up till now, there are no standardized methods. VASI is the most cited and conducted scoring tools [77], but VES has been validated as a clear, time-saving, and user-friendly score for vitiligo evaluation in adults [77,83]. Experts have recommended the use of VES for clinical trial as outcome measure [83,84].…”

Section: Diagnosis Differential Diagnosis and Disease Assessmentmentioning

confidence: 99%

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Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo

Wang

2021

Clinic Rev Allerg Immunol

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Vitiligo is an autoimmune disease of the skin characterized by epidermal melanocyte loss resulting in white patches, with an approximate prevalence of 0.5-2% worldwide. Several precipitating factors by chemical exposure and skin injury present commonly in patients with vitiligo. Although the diagnosis appears to be straightforward for the distinct clinical phenotype and specific histological features, vitiligo provides many challenges including chronicity, treatment resistance, frequent relapse, associated profound psychosocial effect, and negative impact on quality of life. Multiple mechanisms are involved in melanocyte disappearance, including genetics, environmental factors, and immune-mediated inflammation. Compelling evidence supports the melanocyte intrinsic abnormalities with poor adaptation to stressors leading to instability and release of danger signals, which will activate dendritic cells, natural killer cells, and innate lymphoid cells to initiate innate immunity, ultimately resulting in T-cell mediated adaptive immune response and melanocyte destruction. Importantly, the cross-talk between keratinocytes, melanocytes, and immune cells, such as interferon (IFN)-γ signaling pathway, builds inflammatory loops that give rise to the disease deterioration. Improved understanding of the immune pathogenesis of vitiligo has led to the development of new therapeutic options including Janus kinase (JAK) inhibitors targeting IFN-γ signaling pathways, which can effectively reverse depigmentation. Furthermore, definition of treatment goals and integration of comorbid diseases into vitiligo management have revolutionized the way vitiligo is treated. In this review, we highlight recent developments in vitiligo clinical aspects and immune pathogenesis. Our key objective is to raise awareness of the complexity of this disease, the potential of prospective therapy strategies, and the need for early and comprehensive management.

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Section: Diagnosis Differential Diagnosis and Disease Assessmentmentioning

confidence: 99%

Section: Diagnosis Differential Diagnosis and Disease Assessmentmentioning

confidence: 99%

Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo

Wang

2021

Clinic Rev Allerg Immunol

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“…Clinical pattern was classified into generalized, acrofacial, and localized. Vitiligo Extent Score (VES) 13,14 was used for assessment of disease severity. Vitiligo disease activity was evaluated by Vitiligo Disease Activity (VIDA) score, 15 and grading was done as following: +4: new lesions in the last six weeks or less; +3: new lesions in the last six weeks to three months; +2: new lesions in the last three to six months; +1: new lesions in the last six to 12 months; 0: stable for one year or more; −1: stable for one year or more with spontaneous repigmentation.…”

Section: Methodsmentioning

confidence: 99%

Elevated serum level of interleukin‐15 in vitiligo patients and its correlation with disease severity but not activity

Atwa

Ali

Youssef

et al. 2020

J of Cosmetic Dermatology

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Background Vitiligo is a common acquired disorder of depigmentation. Its pathogenesis entails a T helper (Th) 1‐cytotoxic T (cT) lymphocytes mediated autoimmune melanocyte destruction. Interleukin (IL)‐15 is one of the IL‐2 family of cytokines and shares several actions with IL‐2. IL‐15 enhances survival, maturation, and functional activity of natural killer, neutrophils, and dendritic cells. Furthermore, it potentiates survival, maturation, and cytotoxicity of memory cT cells. IL‐15 has been shown to play a crucial role in the pathogenesis of several autoimmune diseases but was poorly investigated in patients with vitiligo. Aims The study aimed at evaluating IL‐15 level in the sera of patients with vitiligo and its association with vitiligo severity and activity. Patients and Methods The study included 30 patients with nonsegmental vitiligo and 30 healthy controls. Vitiligo Extent Score (VES) and Vitiligo Disease Activity (VIDA) score were used to assess vitiligo severity and activity, respectively. Serum level of IL‐15 was assessed by enzyme‐linked immune‐sorbent assay. Results Serum IL‐15 level, in patients with vitiligo, was significantly higher in comparison with the control group (P = .001). A significant positive correlation was found between serum IL‐15 level and VES score (P = .001), whereas there was no significant correlation between IL‐15 level and VIDA score as well as the disease duration. Conclusion IL‐15 level was elevated in the sera of patients with vitiligo. IL‐15 may therefore have a significant impact on vitiligo autoimmune pathogenesis, and further identification of its molecular roles may highlight new therapeutic strategies for vitiligo.

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“…Assessing the area involved by a disease, i.e. the body surface area (BSA), is essential in the initial evaluation of the disease activity and during the follow‐up of the disease course in dermatological patient care 3–5 . In addition, accurate assessment of BSA is a cornerstone for patient education, especially regarding the appropriate amount of topical agent application.…”

Section: Introductionmentioning

confidence: 99%

“…the body surface area (BSA), is essential in the initial evaluation of the disease activity and during the follow-up of the disease course in dermatological patient care. [3][4][5] In addition, accurate assessment of BSA is a cornerstone for patient education, especially regarding the appropriate amount of topical agent application. More recently, for biologic therapies, measuring the objective area of the skin is an important indicator in evaluation before and after the treatment.…”

Section: Introductionmentioning

confidence: 99%

Estimation error of the body surface area in psoriasis: a comparative study of physician and computer‐assisted image analysis (ImageJ)

Yoo

Jeong

Park³

et al. 2022

Clin Experimental Derm

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Background. Assessing the area involved in a skin disease, i.e. the body surface area (BSA), is essential in diagnosing disease severity, including in psoriasis. However, in psoriasis, BSA tends to be overestimated by physicians and has shown high inter-rater and intrarater variability. Furthermore, there are no reports suggesting the cause and clinical significance of overestimating BSA in psoriasiss. Aim. To investigate the errors in estimating BSA in psoriasis by comparing physicians' results with those of computer-assisted image analysis (CAIA) and to provide suggestions regarding the clinical implications of such errors. Methods. Using 43 images, 36 physicians visually estimated BSA in psoriasis, and subsequently, the images were evaluated using a CAIA program (ImageJ); the BSA values determined by the physicians and CAIA were then compared and matched. The BSA percentage was also graded on a scale from 0 to 6, as follows: Grade 0 = no lesion, Grade 1 = 1%-9%, Grade 2 = 10%-29%, Grade 3 = 30%-49%, Grade 4 = 50%-69%, Grade 5 = 70%-89% and Grade 6 = 90%-100%. Each grade range was divided, with the bottom and top 50% defined as the 'first half' and 'second half,' respectively. Results. The mean proportion of correct assessments by physicians was 49.4%. Physicians tended to overestimate the BSA of psoriatic lesions by 8.76% AE 8.82% compared with CAIA. The largest estimation error (proportion incorrect 75.7%) was observed in Grade 3 (30%-49% involvement). Estimates in the second half of the range demonstrated a higher proportion of inaccuracies compared with those in the first half. An overestimating error occurred in certain morphological characteristics of the psoriatic lesions. Conclusions. The inaccuracy of BSA estimation by physicians may be related to the fact that information from the human eye is perceived to be exaggerated compared with the actual size. Further research into using artificial intelligence technology is needed to reduce quantification error and develop an ideal BSA assessment system. Additionally, education and training are needed for physicians to measure BSA accurately.

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Comparative analysis of the body surface area calculation method used in vitiligo extent score vs the hand unit method used in vitiligo area severity index

Cited by 7 publications

References 20 publications

Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo

Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo

Elevated serum level of interleukin‐15 in vitiligo patients and its correlation with disease severity but not activity

Estimation error of the body surface area in psoriasis: a comparative study of physician and computer‐assisted image analysis (ImageJ)

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