1, disease stage: divided into progressive and stable stage. The progressive stage is determined with reference to the vitiligo disease activity score (VIDA) points…, isomorphic reaction, wood lamp.
①VIDA score: new lesions or original lesions enlargement within the last 6 weeks (+4 points), new lesions or original lesions enlargement in the last 3 months (+3 points), new lesions or original lesions enlargement in the last 6 months (+2 points); new lesions or original lesions enlargement in the last 1 year (+1 points); stable for at least 1 year (0 points); stable for at least 1 year with spontaneous pigment regeneration (-1 points).
A total score >1 is considered progressive, and ≥4 is considered rapidly progressive.
② Isomorphic reaction: localized white spots appear within 1 year of skin injury. Injuries include physical (trauma, cuts, scratches), mechanical friction, chemical/thermal burns, allergic (contact dermatitis) or irritant reactions (vaccinations, tattoos, etc.), chronic stress, inflammatory skin diseases, and therapeutic (radiation therapy, phototherapy). White spots occur in areas of constant pressure or friction, or in chronic friction areas of clothing, ornaments, with a specific shape, obviously induced by injury.
③wood light: the color of the lesions is grayish white, the border is less clear, and the area of the lesions under the wood light is larger than the visual area, suggesting a progressive stage. The color of the lesion is white, the border is clear, and the area of the lesion under the wood lamp is ≤ the visual area, suggesting that it is the stable stage.
Progressive stage can be considered if any of the above 3 conditions are met.
④The image changes of laser confocal scanning microscopy (referred to as skin CT) and dermoscopy can be referred to simultaneously to supplement the diagnosis.
2.White spot area (palm area is about 1% of body surface area).
Grade 1 is mild.
3, combination therapy of phototherapy: combination therapy of phototherapy is more effective than monotherapy. Combination therapy mainly includes.
Phototherapy + hormones orally or topically.
phototherapy + topical calcium-regulated neurophosphatase inhibitors.
phototherapy + oral herbal preparations.
phototherapy + topical vitamin D3 derivatives.
phototherapy + topical application of photosensitizers.
phototherapy + transplantation therapy.
phototherapy + oral antioxidants.
Phototherapy + fractional laser treatment.
Phototherapy + dermabrasion, etc.
4. Topical photochemotherapy and oral photochemotherapy: Since their efficacy is not better than NB-UVB and there are many adverse reactions, they have been replaced by NB-UVB.