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Confetti-like depigmentation may signal rapidly progressing vitiligo

Confetti-like depigmentation could be a marker of rapidly progressing vitiligo, according to study results.

Researchers reviewed 178 patient records from a vitiligo registry, including clinical images. Seven patients with a confetti-like pattern of depigmentation fit the study inclusion criteria, which included no treatment in the previous year, baseline and follow-up images and lack of treatment between visits. Three independent reviewers evaluated images of 12 lesions from the patients for percent depigmentation. A second part of the study compared 15 vitiligo patients with confetti-like lesions and 77 patients without confetti-like lesions using the Vitiligo Disease Activity Score (VDAS) and the Koebner Phenomenon in Vitiligo Score (K-VSCOR).

There was a median of 16 weeks between baseline and follow-up images in the first part of the study, with an increase of 23.7% in mean percent depigmentation from 19.2% (95% CI, 12.9-25.5) at baseline to 42.9% (95% CI, 28.3-59.4) at 16 weeks (P = .0097). In the second part of the study, patients with confetti-like lesions had a median VDAS of 4 compared with 1 among patients with confetti-like lesions (P < .001).  The median K-VSCOR was 48 among patients with confetti-like lesions compared with 27for patients without confetti-like lesions (P = .0001).

One patient in the first study cohort had a biopsy specimen of a confetti-like lesion that showed an inflammatory infiltrate in the papillary dermis with CD8+ T cells at the dermoepidermal junction.

“[Confetti-like lesions] may also be a sign of inflammatory vitiligo,” the researchers concluded. “If these findings are confirmed in larger cohorts and other centers, consideration should be given to aggressive treatment of patients with confetti-like lesions to prevent rapid and potentially permanent loss of pigmentation.” – by Bruce Thiel

Disclosure: The authors report no relevant financial disclosures.