Deciphering Activity in Early Facial Vitiligo: A Case Report Integrating Clinical, Wood's Lamp, and Dermoscopic Findings
DOI:
https://doi.org/10.37275/bsm.v9i10.1408Keywords:
Dermoscopy, Disease activity, Inflammation, Non-segmental vitiligo, VitiligoAbstract
Background: The management of non-segmental vitiligo hinges on accurately assessing disease activity to guide appropriate therapy. A clinical challenge arises in patients presenting with a low vitiligo area scoring index (VASI), suggesting limited disease, which may be discordant with underlying inflammatory activity, potentially leading to therapeutic inertia.
Case presentation: A 34-year-old woman with Fitzpatrick skin type III presented with a two-month history of rapidly progressing facial vitiligo, preceded by an erythematous phase. Despite a low VASI score of 1, the patient-reported vitiligo disease activity (VIDA) score was +4. Dermoscopy was instrumental, revealing definitive in-vivo evidence of inflammation and instability, including a pinkish background, telangiectasias, and a reversed pigment network. Based on this discordance between disease extent and activity, a multi-modal therapeutic regimen was initiated. A six-month follow-up demonstrated disease stabilization and significant perifollicular repigmentation, with resolution of the inflammatory dermoscopic signs.
Conclusion: This case report illustrates the critical importance of an integrated diagnostic approach that moves beyond area-based assessment. It highlights how dermoscopy, when used to resolve the clinical paradox of low-extent but high-activity disease, can serve as an objective biomarker to justify timely and robust immunomodulatory intervention. This approach is crucial for altering the disease trajectory and optimizing patient outcomes.
Authors
- Rina Gustia1
- Mutia Sari1
- Afifah Alfyanita1*
- 1Department of Dermatology, Venereology, and Aesthetics, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, Indonesia
Corresponding author Afifah Alfyanita — afifahalfyanita93@gmail.com
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