Classification of Vitiligo Based on its Clinical types / 대한피부과학회지

ABSTRACT

BACKGROUND: Vitiligo is a distressing skin condition in which acquired destruction of melanocytes causes depigmented patches of various shapes & sizes by as yet unclear mechanisms. Its classification is as varied and unresolved as the theories on its pathogenesis, the most plausible of which are autoimmune, neurohumoral and self-destruction theories. OBJECTIVE: Our purpose was to devise a classification scheme which would correlate well with the disease course and prognosis. METHOD: We classified vitiligo into 3 types(symmetric type 1, segmental; type 2, localized; type 3) based on different proposed pathogenetic mechanisms and analyzed the differences between these types in the clinical manifestations of 502 Korean cases. RESULTS: 1. There were 203 males(40.4% ) and 299 females(59.6%). 2. The most frequent clinical type was the symmetric type(49.8%), followed by the localized type(34.1%) and the segmental type(16.1%). 3, The male-to-female ratio was highest in type 2, but not significantly so. 4. Poliosis and halo nevus were associated in 22.3% and 3.8%, respectiuely. 5. The mean age at the first visit was 32.7 years(male, 29.2 years, female; 27.5 years), and there was a significant difference between the clinical types(type 1; 41.0 years, type 2; 20.5 years, type 3; 26.2 years). 6. The mean age of onset was 25.6 years(male; 23.0 years, female; 27.5 years), and there was a significant difference between the clinical types(type 1; 31.3 years, type 2; 15.7 years, type 3; 22.1 years). 7. A family history of vitiligo was observed in 11.2% of patients, whose sisters were most frequently affected, and there was no significant difference between the clinical types. 8. Associated diseases were seen in 12.1% of the patients, the frequency of which was significantly higher in type 1 vitiligo. 9. Abnormal laboratory findings were found in 14.7% and were significantly more common in type 1 vitiligo. CONCLUSIONS: The 3 types differ significantly in the mean age at the first visit, the mean age of onset, disease association and abnormal laboratory findings. Type 1 develops by autoimmune mechanisms, as shown by the continuous progression and the close association with other diseases and abnormal laboratory findings, Types 2 and 3 have a different disease course, becoming stationary after initial progression, Thus, the 3 clinical types classified by the authors are thought to be useful in predicting the course and prognosis of vitiligo and in determining the appropriate therapy. For a more optimal classification, further study on the pathogenesis of vitiligo seems to be in order.