TOPLINE:

An international consensus established that body surface area (BSA) alone is insufficient to capture vitiligo severity, recommended a two-step approach that integrates clinical and psychosocial criteria.

METHODOLOGY:

• Researchers conducted a global mixed-methods consensus study using a multistep approach that included a comprehensive literature review, qualitative study with 30 participants (11 in focus groups and 19 in one-on-one interviews), two rounds of electronic Delphi surveys, and a final consensus meeting.
• A total of 91 individuals (dermatologists, researchers, and individuals with vitiligo from diverse ethnic backgrounds and skin phototypes) from 21 countries across five continents were included, with 85 individuals participating in round 1 of the electronic Delphi survey and 81 individuals in round 2, achieving a 95% response rate in each round.
• The qualitative study involved 30 adults with vitiligo, with data collection through individual interviews and focus groups conducted online.
• The final consensus meeting involved 44 participants (response rate of 54%), including 28 professionals (24 dermatologists) and 16 people with lived experience, who reviewed and refined proposed criteria and definitions through group voting and discussion to ensure validity and completeness.

TAKEAWAY:

• Consensus was reached that measurement of BSA remains a necessary starting point for assessing vitiligo severity, but this measure alone is insufficient to capture disease burden. Vitiligo with 0% to < 3% BSA indicates mild disease, 3% to < 10% BSA indicates moderate disease, and 10% or greater BSA indicates severe disease, with rapidly spreading vitiligo classified as severe regardless of BSA percentage.
• Severity classification incorporated at least one major criterion (spreading/active disease, involvement of highly visible areas, psychological distress, stigmatization, lack of self-acceptance, or overall burden).
• At least two minor criteria, which included younger age, darker skin tone, and impact on daily life, increased risk for sunburn, involvement of scalp/facial hair, and perceived loss of personal or cultural identity, should be met to move patients from the moderate to severe category.
• Researchers defined relapse as loss of pigmentation in previously repigmented lesions (whether repigmentation occurred spontaneously or with treatment), with an appropriate time frame of more than 3 months after treatment cessation, though no consensus was reached on the percentage of pigment loss required.

IN PRACTICE:

“This consensus aims to bridge the gap between physician assessment and patient experience; improve the relevance and consistency of the severity classification in clinical care, research, and regulatory frameworks; and help close the remaining gaps in the diagnosis and classification of vitiligo,” the authors wrote. “ This international consensus statement represents a conceptual and practical shift,” Stanca A. Birlea, MD, PhD, Anastasios Medical Center, Zalău, Romania, wrote in an accompanying editorial. “Rather than proposing yet another scoring instrument,” she added, “the consensus statement established a shared clinical algorithm that reflected the skills of physicians and nonphysician experts and the life experience of patients with vitiligo.”

SOURCE:

This study was led by Viktoria Eleftheriadou, MD, PhD, Vitiligo Clinical and Research Centre for Adult and Paediatric Patients, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, England, and was published online on March 25 in JAMA Dermatology.

LIMITATIONS:

Caregivers of children and adolescents were not included, limiting pediatric perspectives. Participation in the final consensus meeting was lower than in Delphi rounds. The study was conducted in English, limiting participation of nonnative English speakers.

DISCLOSURES:

This study received support from the International League of Dermatological Societies and the European Academy of Dermatology and Venereology. Eleftheriadou and several other authors disclosed serving as a consultant, speaker, or investigator for multiple drug companies, including AbbVie, Almirall, Incyte, MSD, Pfizer, L’Oréal, La Roche-Posay, Boehringer Ingelheim, Beiersdorf, Genesis Pharma, Novartis, and Galderma; being trustees; having patents and stocks; and holding positions with various associations, including the British Association of Dermatologists, UK Dermatology Clinical Trials Network, and Vitiligo Society UK. Additional disclosures are noted in the original article. Birlea did not report any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.