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J Invest Dermatol. 2016 May;136(5):978-984. doi: 10.1016/j.jid.2015.12.040. Epub 2016 Jan 28.

Development and Validation of the Vitiligo Extent Score (VES): an International Collaborative Initiative.

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Department of Dermatology, Ghent University Hospital, Ghent, Belgium. Electronic address:
Department of Dermatology, University of Amsterdam and Netherlands Institute for Pigment Disorders, Amsterdam, The Netherlands.
VU University Medical Center, Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom.
National Reference Center for rare skin diseases, Hôpital St-André, University Hospital Center of Bordeaux, Bordeaux, France.
San Gallicano Dermatology Institute, Via Elio Chianesi, Roma, Italy.
EA EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), UPE-Université Paris-Est, Service de Dermatologie, Hôpital Henri Mondor, Paris, France.
Department of Dermatology, Ghent University Hospital, Ghent, Belgium.


The clinical assessment of vitiligo involves an estimation of the affected body surface area. The most commonly used method is the "palm of hand 1% rule" as integrated in the Vitiligo Area Scoring Index. However, this method can be challenging and time consuming. In this study, we introduce a global Vitiligo Extent Score (VES). In the first part of the study, this measurement instrument was developed and subsequently optimized during a pilot scoring session. In a subsequent stage, the inter- and intrarater reliability of the instrument were tested. Live scoring showed an excellent interrater reliability for the VES (intraclass correlation VES: 0.924 vs. Vitiligo Area Scoring Index: 0.846). Subsequent scoring on pictures was comparable with the live evaluation and demonstrated an excellent intrarater reliability. A high intraclass correlation for the VES (intraclass correlation VES: 0.923 vs. Vitiligo Area Scoring Index: 0.757) was also found in an additional subgroup of patients with extensive vitiligo. Moreover, user-friendliness and timing were scored very favorably. In conclusion, this measurement instrument allows us to monitor accurately and easily the affected body surface area in a standardized way. Moreover, our results provide evidence that the VES can be proposed as a promising tool to measure the vitiligo extent in clinical trials and in daily practice.

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