Latent class analysis of a series of 717 patients with vitiligo allows the identification of two clinical subtypes

Abstract

Non-segmental vitiligo (NSV) is an enigmatic disease with various clinical courses. To empirically identify underlying subtypes of NSV, we performed latent class analysis (LCA) of 717 consecutive patients with NSV seen between 2006 and 2012 and were analyzed. Median age was 32 yrs (14-45), median age at NSV onset was 18 yrs (8-32), and median NSV duration 5 yrs (0.75-78.5). A two-class model showed the best fit. Of the 717 patients, 280 (39%) belonged to LC1 and 437 (61%) to LC2. LC1 patients had high probabilities for early disease onset (<12 yrs), halo nevi, family history of premature hair greying, Koebner phenomenon, previous episodes of repigmentation, and family history of vitiligo. By contrast, LC2 patients were characterized by a late disease onset (after or at the age of 12 yrs, median age of 30 yrs) and acrofacial localization without any lesions on trunk or limbs. These two LCA classes (LC1, 'prepubertal onset'; LC2, 'post-pubertal onset') may help refining results from genome-wide association studies (GWAS) and allow a more accurate genotype-phenotype correlation and help defining more directed treatment protocols.

A Practical Approach to the Diagnosis and Treatment of Vitiligo in Children

“…7 There appear to be 2 subsets of patients with vitiligo: those with early onset (12 years of age or younger) who have more halo nevi, Koebner phenomenon (KP) (lesional development in response to trauma), family history, segmental disease and atopy, and those with late onset who have more acrofacial lesions and thyroid disease (in those older than 12 years). [7][8][9] High estimates of prevalence in pediatric vitiligo are noted when analyzing groups of pediatric patients attending a dermatology clinic. For instance, in Nepal and India, 2.0% and 2.6%, respectively, of children attending a dermatology clinic were diagnosed with vitiligo.…”

“…Interestingly, a recent study based on latent class analysis has distinguished 2 types of vitiligo with probable different pathophysiological pathways. 8 Acrofacial vitiligo is not very common in children. In this form, areas involved are often limited to the face, hands, feet, and orifices.…”

Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials

“…(11) In contrast to traditional regression analyses, in which the goal is to understand the relationship of pre-specified independent variables to a known outcome, LCA models ask whether there are subgroups of patients defined by a combination of the baseline variables, without mandating consideration of the outcome. Latent class-based methods have been extensively used in the social sciences and in other medical disciplines (12, 13) for instance in identification of asthma subphenotypes(14) but have not been highly utilized in critical care. We sought to capitalize on the wealth of clinical and biological data available from two NHLBI-sponsored ARDS Network randomized controlled trials by using LCA methods to attempt to identify and validate novel subphenotypes of ARDS and test their association with clinical outcomes and response to treatment.…”

Premature Greying of Hair (Premature Canities): A Concern for Parent and Child

“…In a controlled study of 125 patients with pernicious anaemia, 11% had premature greying, defined as onset before the age of 20, compared with 2% in the control group [16]. In a recent Latent class analysis of a series of 717 patients with NSV an early age onset (prepubertal onset) class vitiligo was significantly more associated with premature greying as compared to late age onset of vitiligo [17]. Strikingly, in patients with early-onset disease, a higher proportion of familial history of premature hair greying (PHG) was also observed.…”