A prospective observational study of the dermatoscopic findings of non-segmental vitiligo in different stages of evolution.

Introduction: Dermatoscopy has rapidly gained ground as a tool to assess vitiligo activity. However, a methodical approach to assess dermatoscopy in vitiligo and evaluating its role in predicting outcome are still evolving.

Objectives: To compare dermatoscopic findings of individual vitiligo lesions in different stages of evolution and to evaluate its utility to predict outcome at follow-up.

Methods: A total of 171 lesions in 68 patients of non-segmental vitiligo were recruited. Lesions were classified as stable, progressive and repigmenting based on history and/or clinical photography. A total of 101 lesions in 40 patients were followed up at 3 months. The lesions were re-classified based on photographic comparison with baseline images. The dermatoscopic findings included type and distribution of pigment network, margin definition, perifollicular and perilesional pigment, leucotrichia, and eccrine opening discernibility.

Results: Stable lesions showed complete absence of pigment network both at baseline (92.9%) and follow-up (80.9%). Progressive lesions showed variability both in type and distribution of pigment, ill-defined margins (57.6%), and perilesional hypopigmentation (39.7%). Micro-koebnerization, perilesional white globules, peppering of pigment at the periphery of lesion, and loss of pigment in linear pattern in the periphery were specific for progressive disease. Repigmenting lesions demonstrated perilesional (38.3%) and perifollicular hyperpigmentation (76.7%). Well-defined margins and perilesional hyperpigmentation at baseline were associated with lesions remaining stable, whereas lesions with focal/diffuse reduction of pigment and perilesional hypopigmentation and/or white globules were more likely to progress.

Conclusion: Dermatoscopy is useful in determining disease activity and is of potential utility in assessing outcome of vitiligo lesions in a large proportion of cases.