Distribution patterns of vitiligo may help predict progression
MedWire News: Researchers have established the patterns of facial segmental vitiligo, which they say may be valuable for prognosis, including determining the degree and path of lesion spread.
"Patients tend to be concerned with the progression of vitiligo as much as treatment success because they consider vitiligo an incurable, spreading disorder," notes the team.
"For this reason, the ability to predict the clinical course of vitiligo is an important practical issue."
The researchers found that the most frequent pattern, which they termed Type I-a, was seen in 29% of the 257 patients with facial segmental vitiligo who were studied. The pattern broadly started on the middle of the forehead and extended downwards in the midline to the lower cheek on one side.
Segmental vitiligo is the development of milky white spots that result from the loss of pigmentation and form a unilateral distribution.
Co-authors S-K Hann and S Oh, from Yonsei University College of Medicine in Seoul, Korea, identified six subtypes, or patterns, that categorized the condition.
Type I-b lesions, seen in 10% of patients, appeared on the right or left side of the forehead and frequently involved the scalp. These lesions rarely spread down to around the eye area or below.
Type II lesions, affecting 16% of patients, began at the angle of the mouth and then arched to the ear across the cheek or jaw bone, while Type III lesions began below the lower lip and spread down to include the chin and neck.
Type III lesions occurred in 14% of patients and usually spread from the middle of the chin down the middle of the neck.
In the 11% of patients with Type IV, lesions originated on the right side of the forehead and extended to the eyelids, nose and cheek areas, without crossing the midline.
The final subtype was Type V, seen in 9% of patients, and in this subtype lesions were confined to the right eye area.
The different subtypes tended to exist in isolation, with only 11% of patients showing a mixed type, with a combination of Type I and Type II being the most common combination.
The researchers note in the British Journal of Dermatology that various clinical manifestations in each classification type may represent intermediate stages of segmental vitiligo progression.
"Therefore various clinical features in the progressive stages can be used to predict the degree and direction of lesional spread," they conclude.
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By Lucy Piper