Vitiligo - Revolutionizing dermatology by standardized assessment

What is vitiligo?

Vitiligo is a long term disease that causes loss of skin color in patches. It affects approx. 0.5 - 1% of the world's population, and occurs in all races.

Normally, the color of hair and skin is determined by melanin. Vitiligo occurs when cells that produce melanin stop functioning, leading to the appearance of white patches. Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin tone.

Vitiligo signs include:

• Patchy loss of skin color
• Premature whitening or graying of the hair
• Loss of color of mucous membranes

Vitiligo can be focal and localized to one area, or it may affect several different areas on the body. There are two main types of vitiligo, non-segmental and segmental vitiligo. In non-segmental vitiligo, the symptoms often appear on both sides of the body as symmetrical white patches, while in segmental vitiligo, the white patches only affect one area of the body. In rare cases, it is possible for vitiligo to affect the whole body, known as complete vitiligo.

The condition is not life-threatening or contagious, however it can come with psychosocial burden. Patients with vitiligo often have several psychological problems, such as depression, anxiety and shame which can result in low self-esteem and social isolation.

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Traditional scoring methods lack objective assessment

Although skin is the largest organ of the body there are no standardized reproducible methods for assessing skin function or severity of skin disease. Wood's lamp examination is a widely used diagnostic test in which the skin is examined while exposed to the black light emitted by Wood's lamp and is used to identify the extent of pigmented or depigmented patches.

Also, several scoring systems have been introduced to help clinical practice and clinical research on vitiligo. The Vitiligo Area Scoring Index (VASI) and Vitiligo European Task Force (VETF) are widely used scoring systems. VASI measures the extent and degree of depigmentation in six sites: hands, upper extremities, trunk, lower extremities, feet and head/neck. On the other hand, VETF assesses the extent, staging and progression in five sites: head/neck, trunk, arms, legs and hands/feet. Furthermore, it includes a clinical assessment form to record information about the patient (sex, age, family history, Fitzpatrick skin type), the disorder (age of onset, episodes of repigmentation), the impact of vitiligo on QOL and additional medical conditions.

Even though the currently available measurement tools for documentation and assessment of vitiligo are widely used, they do have a number of limitations, such as they are demanding, time consuming and subject to high variability. Professionals are highly dependent on subjective methods, to assess and documentation the manifestation of vitiligo, which are difficult to compare or reproduce. For use in clinical practice, caution is needed when interpreting VASI or similar systems score changes because of the relatively large smallest detectable change (SDC), hence there is a need for a standardized assessment tool which also effectively measures minimal differences.

Digital technology delivers a solution overcoming the limitations of traditional scoring methods

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In a clinical setting, having a reliable, accurate and comparable method for the assessment of disease severity has utmost importance. SCARLETRED is a digital health company introducing standardization and objectivity in the process of skin imaging and assessment.

Scarletred®Vision automatically standardizes the acquired images taken with the app, overcoming inaccuracies resulting from the subjectivity of the currently available assessment tools and methods. Due to compliance to the highest international standards, it is a software well accepted by regulatories for usage in clinical trials worldwide.

The system consists of a mobile app, a web platform and skin patches, which can be easily applied even on sensitive skin types. The app, together with the platform, creates a secure data storage and information flow between patients and professionals, benefiting the quality of healthcare service provided. The real-time based visual documentation grants enhanced efficiency and reliability of the monitoring of skin discoloration and pigmentation disorders, including vitiligo.

Color quantification is based on the objective visual information obtained from the Scarletred®Vision app. The integrated customizable tools allow the standardized assessment of vitiligo using CIELAB color space on the Scarletred®Vision platform. The platform functions as a secure documentation tool providing objective measurement through the integrated remote data monitoring level and built-in customizable service tools, ensuring the safety and objectivity of assessment and monitoring.

Assessment of disease activity is key in clinical management and monitoring of patients with vitiligo. Such trials are dependent on the use of reliable and relevant outcome measures and the standardization of measurement tools is critical. SCARLETRED delivers an innovative digital technology for the monitoring and assessment of vitiligo, overcoming the limitations of traditional scoring methods. Furthermore, the use of the technology ensures reproducibility, comparability and objectivity of assessment, therefore has the potential to increase the quality of dermatological services.

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