Dermatoscopic markers of disease activity in vitiligo.

Background: Determining vitiligo activity is essential for prognosis and treatment planning. Objectives: To describe the dermoscopic findings and correlate them with the activity of the disease. Methods: A single-center, descriptive, analytical study included 233 patients (330 lesions). Lesions were categorized as progressing, repigmenting, stable, or recent. Dermoscopic analysis was performed using a DermLite 4 dermatoscope, with statistical testing through Pearson's chi-square. Results: Progressing lesions were associated with trichrome pattern, reverse network, nacreous white globules, starburst, comet-tail pattern, micro-Koebner phenomenon, residual peripilar pigmentation with leukotrichia, perilesional polka dots, perifollicular depigmentation, and reverse network (P < .01). Stability was indicated by sharp borders (P < .01). Repigmenting lesions exhibited perifollicular or border hyperpigmentation, erythema, and telangiectasias (P < .01). Early vitiligo was suggested by hypopigmented lesions with attenuated network or perifollicular depigmentation (P < .01). Newly identified markers included distally pigmented bicolored hair for recent lesions and proximally pigmented bicolored hair for repigmentation. Limitations: Most patients had prior treatment, potentially influencing dermoscopic patterns. Conclusion: This study, based on a large sample size, identifies specific dermoscopic markers for vitiligo activity and introduces novel findings like bicolored hairs. These insights can refine clinical assessment and serve as a foundation for future research.