Role Of In Vivo Reflectance Confocal Microscopy In Determining Stability In Vitiligo: A Preliminary Study

Vitiligo is the most common acquired hypopigmentary disorder, characterized byprogressive loss of melanocytes. It can be divided into two stages clinically: an activestage and a stable stage. As different stages require different treatments: the stable stageis eligible to surgical treatments and phototherapies, while the active stage is likely torespond to steroids, phototherapy/chemotherapy and immunosuppressants as thesedrugs are used to arrest the disease progression; So it is important to discriminate thesetwo stages. At present, parameter of vitiligo stage judgment include: VIDA score;Kobner Phenomenon; Wood’s lamp examination. But these parameter has it’s ownlimitations and rely mostly on subjective judgements. Therefore, it is necessary tointroduce more objective methodologies in order to improve the accuracy of staging. Invivo reflectance confocal microscopy (RCM) is a real-time，repetitive imaging tool thatprovides non-invasive images at a nearly histological resolution. The role of RCM indifferential diagnosis of melanoma, psoriasis and basal cell carcinoma has been provenand showed high specificity and sensitivity.The aims of our study were to define RCM features of vitiligo phases clinically. Touse pathological observed the performance of the different periods of vitiligo. ObjectiveThe purpose of this study was to define RCM features of vitiligo on differentclinical stages.MethodsA total of125patients with a clinical diagnosis of vitiligo were included in thisstudy. After informed consent, lesional skins of those vitiligo patients werecharacterized by using RCM. Five patients with inflammatory cell infiltration observedat the edge of skin lesions and five patients without inflammatory cell infiltration wereselected. Biopsies were performed at same sites of the RCM examination areas forhistological and immune-histological analysisResultsVIDA score: a rapid active phase group (30patients), a slow active phase group(40patients) and a stable phase group (55patients).RCM show: a rapid active phasegroup (26patients), a slow active phase group (37patients) and a stable phase group (62patients).In the active stage of vitiligo, the RCM examination revealed that the brightdermal papillary rings presented at the dermoepidermal junction level in normal skinlost their integrity or totally disappeared, border between vitiligo lesion and normalskin became unclear, and highly refractile cells which referred to infiltratedinflammatory cells could be seen within the papillary dermis at the edge of the lesions.In the stable stage of vitiligo, the RCM showed a complete loss of melanin in lesionalskin and a clear border between lesional and normal skin. Conclusion:A simple clinical examination with RCM may reliably and efficiently allowevaluation of the stability status of vitiligo lesions. The clinical aspect could be a goodmark to assess the stable phase of vitiligo lesion and it’s activity could be dependent onthe presence or no highly refractile inflammatory cells at the edge of lesion.