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Association of the Köbner Phenomenon With Disease Activity and Therapeutic Responsiveness in Vitiligo Vulgaris
M. D. Njoo, MD;
P. K. Das, MSc, PhD;
J. D. Bos, MD, PhD;
W. Westerhof, MD, PhD
Arch Dermatol. 1999;135:407-413.
Objective To investigate the association between the experimentally induced Köbner phenomenon (KP-e) and the Köbner phenomenon by history (KP-h), disease activity, and therapeutic responsiveness in vitiligo vulgaris.
Design Cohort study.
Setting An outpatient clinic.
Patients Sixty-one consecutive patients with vitiligo vulgaris.
Intervention 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.
Main Outcome Measures 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.
Conclusion 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.
From the Netherlands Institute for Pigmentary Disorders (Drs Njoo and Westerhof) and the Department of Dermatology (Drs Das, Bos, and Westerhof), Academic Medical Centre, Amsterdam, the Netherlands.
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