van Geel N, Passeron T, Wolkerstorfer A, Speeckaert R, Ezzedine K
Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
Department of Dermatology, Université Côte d'Azur, CHU Nice, Nice, France.
Br J Dermatol. 2020 Nov;183(5):883-890. doi: 10.1111/bjd.18950. Epub 2020 Mar 29.
The associations between disease activity and several clinical signs in vitiligo have been described, but a widely accepted and validated scoring system is lacking.
To validate the Vitiligo Signs of Activity Score (VSAS) for physicians.
Three visible clinical signs were scored on 15 body locations: confetti-like depigmentation (c), Koebner phenomenon (k) and hypochromic areas/borders (h). The inter- and intrarater reliability of the global VSAS and VSAS subscores (c-VSAS, k-VSAS and h-VSAS) were tested by four and three raters (physicians), respectively. Construct validity and feasibility were evaluated.
The VSAS demonstrated good inter-rater reliability, with an intraclass correlation coefficient (ICC) of 0·87 in the first round and 0·90 in the second round. The intrarater reliability ICCs were all ≥ 0·86. The inter-rater reliabilities of the subscores were excellent for c-VSAS and fair for k-VSAS and h-VSAS (ICC 0·83, 0·51 and 0·53, respectively, in the first round). Evidence for construct validity was provided. The completion time by the raters (median 2·18 min per patient) improved during the second round (median 1·33 min per patient). A limitation of the study is the low number of patients, mainly of skin phototypes II-III, from a single tertiary centre.
The VSAS appears to be a valid and reliable instrument to score visible clinical signs linked to disease activity in a standardized way. What is already known about this topic? Evidence exists for a possible link between several visible clinical signs in vitiligo and disease activity. A widely accepted and validated scoring system to quantify these clinical signs is lacking. What does this study add? The Vitiligo Signs of Activity Score (VSAS) underwent preliminary validation and may assist quantification of visible clinical signs linked to disease activity in a standardized way in clinical practice and trials. What are the clinical implications of this work? VSAS may be used for future trials that aim to establish the clinical significance of the specific visible clinical signs in vitiligo in a more controlled setting. Linked Comment: Eleftheriadou. Br J Dermatol 2020; 183:801-802.
白癜风疾病活动与多种临床体征之间的关联已有描述，但仍缺乏一个被广泛接受且经过验证的评分系统。
验证供医生使用的白癜风活动体征评分（VSAS）。
对15个身体部位的三种可见临床体征进行评分：纸屑样色素脱失（c）、同形反应（k）和色素减退区域/边界（h）。分别由四名和三名评估者（医生）测试总体VSAS及VSAS各子评分（c-VSAS、k-VSAS和h-VSAS）的评估者间及评估者内信度。评估构想效度和可行性。
VSAS显示出良好的评估者间信度，第一轮组内相关系数（ICC）为0.87，第二轮为0.90。评估者内信度ICC均≥0.86。各子评分的评估者间信度，c-VSAS极佳，k-VSAS和h-VSAS一般（第一轮ICC分别为0.83、0.51和0.53）。提供了构想效度的证据。评估者完成评分的时间（每位患者中位数2.18分钟）在第二轮有所改善（每位患者中位数1.33分钟）。本研究的一个局限性是患者数量较少，主要为来自单一三级中心的皮肤光型II - III的患者。
VSAS似乎是一种有效且可靠的工具，可用于以标准化方式对与疾病活动相关的可见临床体征进行评分。关于该主题已知的信息有哪些？有证据表明白癜风的几种可见临床体征与疾病活动之间可能存在关联。缺乏一个被广泛接受且经过验证的用于量化这些临床体征的评分系统。本研究增加了什么内容？白癜风活动体征评分（VSAS）经过了初步验证，可能有助于在临床实践和试验中以标准化方式量化与疾病活动相关的可见临床体征。这项工作的临床意义是什么？VSAS可用于未来旨在在更可控环境中确定白癜风特定可见临床体征临床意义的试验。相关评论：Eleftheriadou。《英国皮肤病学杂志》2020年；183：801 - 802。
