A reliable instrument is needed to assess vitiligo severity and treatment response.
To assess inter- and intrarater variability and accuracy of the Vitiligo Area Scoring Index among trained raters ...and to evaluate a proposed Vitiligo Area Scoring Index using equidistant 10% depigmentation increments (VASI 10%).
In this prospective study, 12 raters evaluated images of 10 participants with vitiligo on 2 occasions using total body Vitiligo Area Scoring Index (T-VASI) and facial Vitiligo Area Scoring Index (F-VASI) scores after training. Inter- and intrarater reliabilities and accuracy vs digital scores were determined using intraclass correlation coefficients. VASI 10% scores were evaluated separately for interrater reliability and accuracy.
F-VASI interrater reliability improved from “moderate” to “good” between time points, while T-VASI was “good” at both time points. Intrarater reliability ranged from “good” to “excellent” for T-VASI and “poor” to “excellent” for F-VASI. Accuracy intraclass correlation coefficient was “good” to “excellent” for most raters. Interrater reliability using VASI 10% was “moderate” for both T-VASI and F-VASI.
Small participant population and number of raters; participants were not assessed in person; no repeated VASI 10% measures.
Vitiligo Area Scoring Index generally provides good to excellent reliability for assessment of vitiligo by raters who receive standardized training.
Background Existing therapies for vitiligo are limited in efficacy and can be associated with undesirable side effects. Topical Janus kinase inhibitors may offer a new therapeutic option for ...vitiligo. Objective We sought to assess the role of topical ruxolitinib 1.5% cream, a Janus kinase inhibitor, in vitiligo treatment. Methods This 20-week, open-label, proof-of-concept trial of twice-daily topical ruxolitinib 1.5% cream was conducted in 12 patients with a minimum of 1% affected body surface area of vitiligo. The primary outcome was percent improvement in Vitiligo Area Scoring Index from baseline to week 20. Results Of 12 patients screened, 11 were enrolled and 9 completed the study (54.5% men; mean age, 52 years). Four patients with significant facial involvement at baseline had a 76% improvement in facial Vitiligo Area Scoring Index scores at week 20 (95% confidence interval, 53-99%; P = .001). A 23% improvement in overall Vitiligo Area Scoring Index scores was observed in all enrolled patients at week 20 (95% confidence interval, 4-43%; P = .02). Three of 8 patients responded on body surfaces and 1 of 8 patients responded on acral surfaces. Adverse events were minor, including erythema, hyperpigmentation, and transient acne. Limitations Limitations of the study include the small sample size and open-label study design. Conclusions Topical ruxolitinib 1.5% cream provided significant repigmentation in facial vitiligo and may offer a valuable new treatment for vitiligo.
Vitiligo is a chronic autoimmune disorder characterized by depigmented patches of the skin.
To evaluate the efficacy and safety of ritlecitinib, an oral JAK3 (Janus kinase)/TEC (tyrosine kinase ...expressed in hepatocelluar carcinoma) inhibitor, in patients with active nonsegmental vitiligo in a phase 2b trial (NCT03715829).
Patients were randomized to once-daily oral ritlecitinib ± 4-week loading dose (200/50 mg, 100/50 mg, 30 mg, or 10 mg) or placebo for 24 weeks (dose-ranging period). Patients subsequently received ritlecitinib 200/50 mg daily in a 24-week extension period. The primary efficacy endpoint was percent change from baseline in Facial-Vitiligo Area Scoring Index at week 24.
A total of 364 patients were treated in the dose-ranging period. Significant differences from placebo in percent change from baseline in Facial-Vitiligo Area Scoring Index were observed for the ritlecitinib 50 mg groups with (−21.2 vs 2.1; P < .001) or without (−18.5 vs 2.1; P < .001) a loading dose and ritlecitinib 30 mg group (−14.6 vs 2.1; P = .01). Accelerated improvement was observed after treatment with ritlecitinib 200/50 mg in the extension period (n = 187). No dose-dependent trends in treatment-emergent or serious adverse events were observed across the 48-week treatment.
Patients with stable vitiligo only were excluded.
Oral ritlecitinib was effective and well tolerated over 48 weeks in patients with active nonsegmental vitiligo.
In this study, we present a novel preparation process named vacuum-assisted slurry infiltration (VASI) for obtaining the SiO2 f/SiO2 composites. This method displays remarkably improvement in ...manufacturing cycles since it allows adopt the ceramic slurries with high solid content as well as low viscosity. Through the porous matrix design of combining coarse particles with fine particles, a homogeneous porous matrix is achieved. The SiO2 f/SiO2 composites prepared by the VASI method exhibit the rivaling flexural and tensile strength at 48.8 and 16.4 MPa, respectively. Meanwhile, such porous matrix can enable cracks deflecting and dissipating crack energy by fiber pullout and fiber debonding mechanisms. In comparison, composites fabricated via silica sol infiltration show lower mechanical properties and brittle fracture behavior due to the formation of some defects in the matrix. This work make the prospect for meeting the requirements of low-cost, short preparation cycles, and near-net-shape manufacturing technology for SiO2 f/SiO2 composites becomes realizable.
Facial involvement of vitiligo is an important factor in a patient's life and has often been evaluated separately from body surface area in clinical trials. However, no reliable tools to measure ...facial vitiligo specifically are available thus far.
To develop and validate a practical instrument for assessing facial vitiligo.
The ratios of a hand to a fingertip unit (FTU) of 98 healthy volunteers (age range, 2-69 years) were calculated to define the FTU. Facial Vitiligo Area Scoring Index was measured as the sum of all FTUs of each vitiligo lesion on the face (range, 0-112 FTU). In the validation study, 6 raters evaluated 11 patients with facial vitiligo twice at an interval of 2 weeks.
One hand was measured at 32.1 ± 1.3 FTU, which was highly consistent among subjects across different age groups, sexes, and races. Facial Vitiligo Area Scoring Index showed remarkably high accuracy (concordance correlation coefficient, 0.946; smallest detectable change, 2.2 FTU) as well as high intrarater reliability (intraclass correlation coefficient, 0.903; inter-rater reliability, 0.903).
Lack of dynamic validation of responsiveness.
Facial Vitiligo Area Scoring Index using the FTU is an intuitive, precise, and reliable instrument for assessing the extent of facial involvement in vitiligo patients.
Marta Pestarino and Irò B. Camici review Heiner Schwarzberg and Valeska Becker (eds), Bodies of Clay on Prehistoric Humanised Pottery. Proceedings of the Session at the 19th EAA Annual Meeting at ...Pilsen, 5th September 2013, Philadelphia: Oxbow Books, 2017
Science education researchers agree that a better understanding of Scientific Inquiry (SI) is one of the main objectives of Scientific Literacy. Considering the Brazilian scenario in which SI is ...being implemented as a proposal for science education based on Base Nacional Comum Curricular (BNCC), the aim of this study was to assess the notions of 169 elementary school students regarding SI by administering the VASI questionnaire. This study had a qualitative approach, we categorized the answers in Naïve, Mixed and Informed according to the 8 aspects of SI proposed on the original questionnaire. A low percentage of answers were classified as Mixed or Informed. The results corroborate to the argument that activities that prioritize the doing inquiry do not necessarily lead the students knowing inquiry. We consider that the VASI questionnaire can be applied by teachers now that different curricula based on investigation are been adopted in Brazil.
Resumo: Pesquisadores em Ensino de Ciências concordam que um melhor entendimento da investigação científica (IC) é um dos principais objetivos da literacia científica. Considerando o cenário brasileiro, no qual o IC vem sendo implementado como proposta para a educação científica baseada na Base Nacional Comum Curricular, o objetivo deste estudo foi avaliar as noções de 169 alunos do Ensino Fundamental II acerca da IC por meio do questionário VASI. Este trabalho teve uma abordagem qualitativa, e categorizamos as respostas em Ingênuo, Misto e Informado, de acordo com os oito aspectos da IC proposto no questionário inicial. Uma baixa porcentagem das respostas foi considerada como Misto ou Informado. Os resultados corroboram com o argumento de que atividades que priorizam o fazer investigativo não necessariamente levam os estudantes a conhecer a IC. Consideramos que o questionário VASI pode ser aplicado por professores, já que diferentes currículos baseados em investigação estão sendo adotados no Brasil.
Vitiligo is an autoimmune disorder of melanocyte characterized by macular and depigmented patches. There are several treatment modalities for this disease, including the use of corticosteroids, ...calcineurin inhibitors, vitamin D analogous and topical phenytoin. Combination therapy utilizing fractional CO2 laser with different topical agents has been used to enhance treatment response with promising results. In this study, we aimed to evaluate the effect of fractional CO2 laser in combination with topical phenytoin. In this study, 25 patients (11 females and 14 males) with age of 18–59 (mean age of 31.12) with nonsegmental stable vitiligo were recruited with insufficient response to at least 1‐year treatment with a monotherapy using topical corticosteroids, calcineurin inhibitors, and/or NB‐UVB phototherapy. Patients were treated with a combination of fractional CO2 laser (10,600 nm, pulse energy 30–50 mJ, MIXEL, South Korea, Rating: 220VAC, 3A, 50/60 Hz) with monthly intervals for six sessions and application of phenytoin 1% cream twice daily. Photography was done before and after treatment with Wood's lamp. The severity of disease using VASI score was calculated and compared before and after treatment. The mean VASI score before treatment was 0.55, and sixth month after treatment increased to 1.97 (p‐value < 0.001). Patients were divided into three groups based on the vitiligo subtype: acral, upper extremities, and trunk. VASI score was measured in each group: VASI score before and after treatment was 0.50 and 1.48 in acral areas, 0.45 and 2.04 in upper extremities and 0.79 and 3.39 in trunk, respectively. This study revealed that combination therapy with phenytoin and fractional CO2 laser is effective in treatment of vitiligo not only in the upper extremities and trunk, but also interestingly in the acral areas.
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