Vitiligo evolving badly: the « Confetti-like macule sign »
- The evolution of vitiligo is difficult to predict and follicular regimentation is a sign of positive evolution ov vitiligo often, when undergoing treatment.
- Conversely there is apparently a sign of unfavorable of evolution: confetti-like marks
- These are small irregular (confetti shaped) macules on the periphery of preexisting vitiligo lesions in patients with extensive vitiligo vulgaris (generalized vitiligo).
- In this study from the United States, the authors identified 15 patients out of 178 with confetti-like depigmentation.
- Following photograph of the lesions in 13 patients (baseline and at follow-up (16 weeks later)), and evaluation by 3 independent reviewers, the authors found that the lesions evolved.
- According to the VASI (Vitiligo Area Scoring Index), the mean percent of depigmentation of lesions was 19% and increased to 51% (it increased to 71% in 2 patients seen 31 weeks later) (all results statistically significant)
- This is important, as their appearance could warrant a more aggressive treatment as well as give to the patient probable negative prognostic evolution information.
PS: in one patient biopsy of a confetti-like lesion was performed at baseline revealing an inflammatory infiltrate of CD8+ cells was found at the dermo-epidermal junction
- Depigmented pinpoint macules have already been described as a sign of worsening but these lesion are on perifollicular skin which is not the case here. Also the lesions are not always pinpoint (around 1 mm in diameter), hence the term confetti-like.
- It would be interesting to do a prospective study as well as measure biological indicators of auto-immune activity as well as measure markers on skin biopsies done at baseline and at follow-up.
Contributors Dr Christophe Hsu – dermatologist. Geneva, Switzerland
Source of information: Confetti depigmentation as a disease marker in patients with generalized vitiligo. P141 – Pandya A. et al. IPCC2014 Singapore