Association of the Köbner phenomenon with disease activity and therapeutic responsiveness in vitiligo vulgaris.
OBJECTIVE
To investigate the association between the experimentally induced Kobner phenomenon (KP-e) and the Kobner phenomenon by history (KP-h), disease activity, and therapeutic responsiveness in vitiligo vulgaris.


METHODS
Cohort study.


METHODS
An outpatient clinic.


METHODS
Sixty-one consecutive patients with vitiligo vulgaris.


METHODS
Three months after a standardized epidermodermal injury was induced, the KP-e was evaluated. For 1 year, UV-B (311 nm) therapy or topical fluticasone propionate plus UV-A therapy was given, depending on the severity of depigmentation.


METHODS
The presence or absence of the KP-e and the KP-h disease activity as scored on a 6-point scale from -1 to +4 (vitiligo disease activity [VIDA] score) and therapy-induced repigmentation grade.


RESULTS
Nineteen (31%) of the patients had a positive KP-h, whereas 37 (61%) showed a positive KP-e (P<.001). The VIDA score did not always predict a positive KP-e, although patients with a positive KP-e had a higher mean VIDA score (VIDA score of 1.6) than did patients with a negative KP-e (VIDA score of 0.5) (P<.001). The responsiveness to UV-B (311 nm) therapy among KP-e-positive or KP-e-negative patients was not significantly different (P=.66). However, KP-e-positive patients who were treated with fluticasone propionate plus UV-A showed a better response than did KP-e-negative patients (P=.01). Among patients responding to both therapies, VIDA scores were significantly decreased (P<.001) compared with VIDA scores before therapy.


CONCLUSIONS
The KP-e may function well as a clinical factor to assess present disease activity and may also predict the responsiveness to fluticasone propionate plus UV-A therapy but not to UV-B (311 nm) therapy.
Njoo
M D
MD
Netherlands Institute for Pigmentary Disorders, Academic Medical Centre, Amsterdam. davidnjoo@hotmail.com
Das
P K
PK
Bos
J D
JD
Westerhof
W
W
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000730:Androstadienes / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D005260:Female; D000068298:Fluticasone; D005500:Follow-Up Studies; D005938:Glucocorticoids; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000293:injuries* / Q000473:pathology; D014467:Ultraviolet Therapy; D014820:Vitiligo / Q000209:etiology* / Q000473:pathology / Q000628:therapy*
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D000068298:Fluticasone