Clinical repigmentation patterns in paediatric vitiligo.

BACKGROUND: Repigmentation is an essential outcome measure in vitiligo. However, clinical studies describing vitiligo repigmentation patterns are lacking. OBJECTIVES: To assess and clearly define the repigmentation patterns in a series of patients with vitiligo, correlating these with clinicoepidemiological characteristics. METHODS: Patients with vitiligo seen at least at twice (initial consultation and follow-up visit) in the Department of Paediatric Dermatology, Hôpital Pellegrin des Enfants, Bordeaux University Hospital from 2006 to 2014 were included. Clinical photographs and case records were reviewed. RESULTS: There were 109 patients (64 female, 45 male) mostly with Fitzpatrick skin type III (n = 67, 61%). The majority had nonsegmental (n = 71, 65%) or segmental vitiligo (n = 29, 27%). In total 172 representative vitiligo lesions were analysed. Overall, a combined pattern of repigmentation was most commonly seen (n = 106, 62%). The combined pattern occurred more frequently in patients with segmental vs. nonsegmental vitiligo (P = 0·009), whereas the diffuse pattern was more frequent in the latter (P = 0·007). Diffuse repigmentation was the predominant pattern on the eyelids (P < 0·001). We observed a new pattern in sites with few to absent hair follicles, which we propose to call 'medium spotted repigmentation'. This begins as circular macules of repigmentation, wider than 5 mm in diameter, which, from the outset, are larger than the initial macules of perifollicular repigmentation. This study is limited by its retrospective nature and small sample size for subgroup assessment. CONCLUSIONS: The combined pattern of repigmentation was most frequently observed. Medium spotted repigmentation is a new pattern, which will benefit from larger studies for a better understanding.

Pilot study of an automated method to determine Melasma Area and Severity Index.

BACKGROUND: Objective outcome measures for melasma severity are essential for the evaluation of severity as well as results of treatment. The modified Melasma Area and Severity Index (mMASI) score is a validated tool for assessing melasma severity but is often subject to inter-observer variability. OBJECTIVES: To develop and validate a novel image analysis software designed to automatically calculate the area and degree of hyperpigmentation in melasma from computer image analysis of whole-face digital photographs, thereby deriving an automated mMASI score (aMASI). METHODS: The algorithm was developed in collaboration between dermatologists and image analysis experts. Firstly, using an adaptive threshold method, the algorithm identifies, segments and calculates the areas involved. It then calculates the darkness. Finally, the derived area and darkness are then used to calculate mMASI. The scores derived from the algorithm are validated prospectively. Twenty-nine patients with melasma using depigmenting agents were recruited for validation. Three dermatologists scored mMASI at baseline and post-treatment using standardized photographs. These scores were compared with aMASI scores derived from computer analysis. RESULTS: aMASI scores correlated well with clinical mMASI pre-treatment (r = 0·735, P < 0·001) and post-treatment (r = 0·608, P < 0·001). aMASI was reliable in detecting changes with treatment. These changes in aMASI scores correlated well with changes in clinician-assessed mMASI (r = 0·622, P < 0·001). CONCLUSIONS: This study proposes a novel approach in melasma scoring using digital image analysis. It holds promise as a tool that would enable clinicians worldwide to standardize melasma severity scoring and outcome measures in an easy and reproducible manner, enabling different treatment options to be compared accurately.

Repigmentation of leucotrichia in vitiligo with noncultured cellular grafting.

BACKGROUND: Vitiligo in hair-bearing areas is often associated with leucotrichia. Repigmentation of leucotrichia has been reported mainly with tissue and follicular hair grafts. OBJECTIVES: To evaluate the repigmentation response of leucotrichia after noncultured cellular grafting. METHODS: We retrospectively reviewed patients with stable generalized and segmental vitiligo who underwent noncultured cellular grafting from March 2008 to November 2010 in areas with leucotrichia. The percentage repigmentation of white hairs was based on clinical assessment and standardized digital photography, and was graded 'poor', 'fair', 'good' or 'excellent', corresponding to a scale of 0-100% repigmentation with respective intervals of 25%. RESULTS: Eighty-four patients with vitiligo underwent cellular grafting; of these, 13 had grafting in areas with leucotrichia. Twelve patients (92%) had poor repigmentation of leucotrichia 3 months after transplant. One patient defaulted follow-up after this period. At 6months, fair repigmentation was achieved in eight out of the 12 remaining patients (67%). After 9-12months, however, 91% (10 out of 11) of the patients achieved good or excellent repigmentation. One patient did not reach the 9-month follow-up period at the time of data analysis. Leucotrichia of eyebrows yielded excellent repigmentation in eight out of nine patients, whereas hairs on the limbs and scalp showed good repigmentation in two out of two patients at 9-12 months. CONCLUSIONS: Good to excellent repigmentation of leucotrichia can be achieved with noncultured cellular grafting, obviating the need for hair transplantation.

Lymphomatoid papulosis: is a second lymphoma commoner among East Asians?

BACKGROUND: Lymphomatoid papulosis (LyP) is a low-grade cutaneous lymphoma, which lies within the spectrum of primary cutaneous CD30-positive lymphoproliferative disorders. Around 10-20% of LyP cases are associated with a second lymphoma. AIM: To analyse a cohort of Asian patients with LyP, diagnosed from 1987 to 2007 at the National Skin Centre (NSC), Singapore, in terms of epidemiology, treatment and association with a second lymphoma. METHODS: Patients were identified through the NSC clinical and histological databases. RESULTS: During this period, 13 patients were diagnosed with LyP based on clinicopathological criteria. The mean age at diagnosis was 41 years, the male : female ratio was 2.3 : 1, and 92% of the patients were Chinese. Recurrent papulonecrotic lesions were present for a mean of 3 years before diagnosis. Treatment of LyP comprised monotherapy (n = 4) or combination therapy (n = 9) using corticosteroids, oral antibiotics, methotrexate and/or phototherapy. Mean duration of follow-up was 6.4 years. Eight patients (61.5%) were diagnosed with a second lymphoma, either before (n = 2), concurrently with (n = 1) or after (n = 5) the diagnosis of LyP. Mycosis fungoides (MF) was the commonest lymphoma (78%, n = 7), followed by primary cutaneous anaplastic large-cell lymphoma (12%, n = 2). There was one death (mortality rate 7.7%), which occurred in a patient who had developed stage IIA MF after LyP, which subsequently progressed to systemic T-cell lymphoma. CONCLUSIONS: LyP is a chronic, relapsing disease with considerable morbidity, but an overall good prognosis. A strikingly large proportion of our Asian patients (61.5%) had a second lymphoma, compared with previous studies. This emphasizes the importance of regular lifetime surveillance for associated lymphomas in all patients with LyP.

Primary cutaneous nodular amyloidosis initially presenting with eczema.

We report an unusual case of a 76-year-old woman with primary cutaneous amyloidosis who initially presented with features of asteatotic eczema that was unresponsive to topical corticosteroid treatment. Histological examination revealed amyloid deposits involving the superficial and deep dermis. These lesions later gradually evolved into erythematous nodules, and a second biopsy performed 29 months after the initial presentation again revealed diffuse collections of amyloid throughout the dermis. Further investigations did not reveal evidence of systemic involvement, thus indicating a diagnosis of primary cutaneous nodular amyloidosis. The initial presentation as eczematous lesions illustrates the importance of clinicopathological correlation and subsequent follow-up.