Assessment and therapy of vitiligo

Vitiligo is a common skin disorder causing depigmented macules that can alter a patient's appearance and impair a patient's quality of life. This thesis contains studies on different methods of assessment of vitiligo and their quality as well as studies assessing repigmentation and depigmentation therapies in vitiligo and piebaldism.
Currently, there are no standardized outcome measures to assess the degree of depigmentation. Moreover, there is limited knowledge on the measurement properties of outcome measures in vitiligo. The reliability and responsiveness of the VASI and the VETFa, two well described clinician reported outcomes for vitiligo, showed to be reliable and responsive instruments to assess the degree of depigmentation in vitiligo. Furthermore, the SAVASI, a new self-assessment tool showed to be a valid, reliable, and acceptable self-assessment tool to measure the degree of depigmentation in vitiligo.
In stable depigmented lesions unresponsive to topical and phototherapy, autologous transplantation is the treatment option of choice to induce repigmentation. In this thesis the outcomes of repigmentation therapies were assessed. The efficacy and safety of different punch depths and punch sizes in autologous punch grafting were compared. Furthermore, the CST-CED method was demonstrated to result in a high percentage of repigmentation and was well tolerated.
In widespread vitiligo, when repigmentation therapies are no longer feasible, Q-switched lasers can be used to remove the remaining disfiguring pigmentation. QSR laser therapy showed in a retrospective study to be effective in approximately half of the patients and a safe treatment with a high patients’ satisfaction.