Dave Shriya, Thappa Devinder Mohan, Dsouza Mariette
Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry-605 006, India.
Indian J Dermatol Venereol Leprol. 2002 Nov-Dec;68(6):323-5.
The significant inter-patient variability in progression, and response to therapy makes it a great challenge for the physician to predict the outcome of vitiligo at the very outset. Subjective factors like stress, pregnancy, sunburn and illness have been identified as aggravating factors for vitiligo. However, a few studies have evaluated the statistical significance of objective clinical parameters in predicting the outcome of vitiligo. Our retrospective analysis of 199 consecutive patients with vitiligo who presented to our OPD was aimed at evaluation of these objective clinical parameters utilizing a standard proforma. Patients already on treatment, and those with duration of disease less than 6 months were excluded from the study. Progression was defined as an increase in size or number of lesions in the 3 months prior to presentation. In all 76.9% patients had progression of vitiligo. The clinical parameters significantly associated with progression were a positive family history (p=0.027), mucosal involvement (p=0.032), Koebner's phenomenon (p=0.036) and nonsegmental vitiligo (p=0.033). Thrichrome sign, leucotrichia, longer duration and higher age at onset did not correlate significantly with progression. The one significant observation that we found to have the poor prognostic implication in vitiligo is the presence of mucosal vitiligo. The clinical prediction of disease progression at the outset enables the physician to set realistic treatment goals and optimize the therapeutic regimen for the individual patient.
患者在病情进展和对治疗反应方面存在显著的个体差异，这使得医生在疾病初期预测白癜风的预后成为一项巨大挑战。压力、怀孕、晒伤和疾病等主观因素已被确定为白癜风的加重因素。然而，少数研究评估了客观临床参数在预测白癜风预后方面的统计学意义。我们对连续199例到门诊就诊的白癜风患者进行回顾性分析，旨在使用标准表格评估这些客观临床参数。已接受治疗的患者以及病程少于6个月的患者被排除在研究之外。病情进展定义为就诊前3个月内皮损大小或数量增加。所有患者中，76.9%有白癜风进展。与病情进展显著相关的临床参数为阳性家族史（p = 0.027）、黏膜受累（p = 0.032）、同形反应（p = 0.036）和非节段性白癜风（p = 0.033）。三色征、白发、病程较长和发病年龄较大与病情进展无显著相关性。我们发现白癜风中一个具有不良预后意义的重要观察结果是黏膜白癜风的存在。在疾病初期对病情进展进行临床预测可使医生设定现实的治疗目标并为个体患者优化治疗方案。
