Confetti-like depigmentation: A potential sign of rapidly progressing vitiligo

Sosa, J; Currimbhoy, Sharif; Ukoha, Uzoamaka T.; Sirignano, Samantha; O’Leary, Ryan; Vandergriff, Travis; Hynan, Linda S.; Pandya, Amit G.

doi:10.1016/j.jaad.2015.05.014

Cited by 65 publications

(61 citation statements)

References 8 publications

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Section: Resultsmentioning

confidence: 99%

“…Pinpoint depigmented macules, also called confetti‐like or punctate depigmentation, have been related to disease progression in vitiligo . Confetti depigmentation was defined as numerous non‐follicular 1–5 mm achromic macules in groups . Confetti‐like depigmentations were reported to be present in 4.76–46% of cases and were often seen in combination with trichrome/hypochromic lesions .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical visible signs of disease activity in vitiligo: a systematic review and meta‐analysis

Geel

Grine

Wispelaere

et al. 2019

Acad Dermatol Venereol

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Vitiligo is an unpredictable depigmenting disorder for which a static method to assess disease activity is lacking. Presence of certain skin manifestations may be indicative of disease activity. Here, we evaluated the current evidence for an association between clinical signs and reported disease activity in vitiligo. A systematic review and meta‐analysis was performed based on a search in PubMed, Embase and Cochrane Library. Literature reporting skin manifestations and disease activity was analysed based on descriptive analyses and, if applicable, odd ratios. Forty‐six observational studies were selected and analysed, including 28 case reports. Reported clinical signs in relation to active vitiligo were as follows: Koebner's phenomenon, confetti‐like depigmentations, tri‐ and hypochromic lesions (including poorly defined borders), inflammatory borders/areas, itch and leukotrichia. Based on this search, strong evidence was found for Koebner's phenomenon. Poorly defined borders and confetti lesions are potential markers, although more data are needed to confirm this. Evidence for other skin manifestations was inconclusive, whereas case reports on inflammatory borders were indicative of active disease. Limitations included the lack of randomized controlled trials, large‐scale prospective studies and heterogeneity due to inconsistent definitions. This systematic review urges the vitiligo community to come forward with consensus‐based definitions as well as a reliable scoring system to assess these clinical signs and to design optimal trials to investigate their true predictive value.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical visible signs of disease activity in vitiligo: a systematic review and meta‐analysis

Geel

Grine

Wispelaere

et al. 2019

Acad Dermatol Venereol

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show abstract

“…Three sites were selected for sampling – one was a site of vitiligo that did not previously respond to treatment with tofacitinib, one was a recently active site (featuring confetti depigmentation 22 ) that previously responded to tofacitinib, and one was unaffected skin.…”

Section: Methodsmentioning

confidence: 99%

Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure

Liu

Strassner

Refat

et al. 2017

Journal of the American Academy of Dermatology

169

142

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BACKGROUND Vitiligo is an autoimmune disease wherein cutaneous depigmentation occurs. Existing therapies are often inadequate. Prior reports have shown benefit of the Janus kinase (JAK) inhibitors. OBJECTIVE To evaluate the efficacy of the JAK 1/3 inhibitor, tofacitinib, in the treatment of vitiligo. METHODS This is a retrospective case series of 10 consecutive patients with vitiligo treated with tofacitinib. Severity of disease was assessed by body surface area of depigmentation. RESULTS Ten consecutive patients were treated with tofacitinib. Five patients achieved some repigmentation at sites of either sunlight exposure or low-dose nbUVB. Suction blister sampling revealed that the autoimmune response was inhibited during treatment in both responding and non-responding lesions, suggesting that light was primarily required for melanocyte regeneration, rather than immunosuppression. LIMITATIONS Limitations include the small size, retrospective nature, and lack of a control group. CONCLUSION Treatment of vitiligo with JAK inhibitors appears to require light exposure. In contrast to treatment with phototherapy alone, repigmentation during treatment with JAK inhibitors may require only low-level light. Maintenance of repigmentation may be achieved with JAK inhibitor monotherapy. These results support a model wherein JAK inhibitors suppress T cell mediators of vitiligo and light exposure is necessary for stimulation of melanocyte regeneration.

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“…Active vitiligo lesions were chosen based on a one-month history of new lesions and the presence of confetti-like depigmentation or trichrome lesions 19,20 . In stable subjects, selected sites were along the lesional edge with overlap between normal and depigmented skin.…”

Section: Methodsmentioning

confidence: 99%

Suction blistering the lesional skin of vitiligo patients reveals useful biomarkers of disease activity

Strassner

Rashighi

Refat

et al. 2017

Journal of the American Academy of Dermatology

101

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Background Vitiligo is an autoimmune disease of the skin with limited treatment options; there is an urgent need to identify and validate biomarkers of disease activity to support vitiligo clinical studies. Objective To investigate potential markers of disease activity directly in the skin of vitiligo subjects and healthy subjects. Methods Patient skin was sampled via a modified suction blister technique allowing for minimally invasive, objective assessment of cytokines and T cell infiltrates in interstitial skin fluid. Potential biomarkers were first defined and later validated in separate study groups. Results In screening and validation, CD8+ T cell number and CXCL9 protein concentration were significantly elevated in active lesional compared to non-lesional skin. CXCL9 protein concentration achieved greater sensitivity and specificity by ROC analysis. Suction blistering also allowed for phenotyping of the T cell infiltrate, which overwhelmingly expresses CXCR3. Limitations A small number of patients were enrolled for the study, including a single patient to define the treatment response. Conclusion Measuring CXCL9 directly in the skin may be effective in clinical trials as an early marker of treatment response. Additionally, use of the modified suction blister technique supports investigation of inflammatory skin diseases using powerful tools like flow cytometry and protein quantification.

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Confetti-like depigmentation: A potential sign of rapidly progressing vitiligo

Cited by 65 publications

References 8 publications

Clinical visible signs of disease activity in vitiligo: a systematic review and meta‐analysis

Clinical visible signs of disease activity in vitiligo: a systematic review and meta‐analysis

Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure

Suction blistering the lesional skin of vitiligo patients reveals useful biomarkers of disease activity

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