10.5826/dpc.1401a3
text/xml
2160-9381
3130
en
Davinder Parsad
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Vitiligo
Validating a Novel Technique of Dermatoscopic Imaging or Sequential Comparison of Target Lesions in Vitiligo 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2024-01-31
2023-01-02
2024-01-31
2024-02-21
e2024003
Dermatol Pract Concept
Davinder Parsad
2024/01/31
10.5826/dpc.1401a3
e2024003
Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India 
2160-9381
Vitiligo
en
e2024003
Xie Y, Bai J, Han L, Xia Y, Li L, Wan M. A novel way of mapping in Mohs micrographic surgery. J Am Acad Dermatol. 2021;85(3):e145-e146. doi:10.1016/J.JAAD.2019.03.019
Validating a Novel Technique of Dermatoscopic Imaging or Sequential Comparison of Target Lesions in Vitiligo 
https://dpcj.org/index.php/dpc/article/download/3130/2456
      Validating a Novel Technique of Dermatoscopic
       Imaging or Sequential Comparison of Target
                    Lesions in Vitiligo
             Priyansh Gupta1, Anubha Dev1, Keshavamurthy Vinay1, Anuradha Bishnoi1,
                           Muthu Sendhil Kumaran1, Davinder Parsad1


1 Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India



Key words: dermatoscopy, vitiligo, imaging, novel
Citation: Gupta P, Dev A, Vinay K, Bishnoi A, Sendhil Kumaran M, Parsad D. Validating a Novel Technique of Dermatoscopic Imaging
or Sequential Comparison of Target Lesions in Vitiligo. Dermatol Pract Concept. 2024;14(1):e2024003. DOI: https://doi.org/10.5826/
dpc.1401a3
Accepted: February 13, 2023; Published: January 2024
Copyright: ©2024 Gupta et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Keshavamurthy Vinay, Associate Professor, Department of Dermatology, Venereology and Leprology, Post Graduate
Institute of Medical Education and Research, Chandigarh, India- 160012. Phone: +91-8872993222 Email: vinay.keshavmurthy@gmail.com




Introduction                                                             Thirty patients of active vitiligo (defined as occurrence of
                                                                         new lesions or expansion of pre-existing lesions in the pre-
Sequential dermatoscopy can be a handy tool to assess dis-               vious 6 weeks) were recruited. Two target lesions were iden-
ease activity in vitiligo and hence guide management prac-               tified in each patient and dermatoscopic assessment was
tices [1]. However, the small size of the contact plate of hand          performed at baseline and after 16 weeks of medical treat-
held dermatoscopes prevents the adequate capturing of im-                ment resulting in 60 pairs of pre and post treatment photo-
ages of larger patches in entirety. “Wide area digital dermos-           graphs. The detailed methodology of patient recruitment and
copy” (WADD) and Video-WADD, are certain modifications                   follow-up has previously been published [4].
used to acquire images of lentigo maligna and congenital                      The reference points in the target lesion were marked
melanocytic nevus [2,3]. This study aimed at devising a new              according the markings on a clock, using different colored
method to acquire and store dermatoscopic images of vitil-               pens, akin to the technique used in Mohs micrographic sur-
igo patches in entirety, which would facilitate easy sequential          gery (Figure 1) [5]. Dermatoscopic images were acquired
comparison.                                                              from each quadrant, while maintaining an overlap of 10%
                                                                         between images. Both lesional and perilesional skin were in-

Case Presentation                                                        cluded as marginal lesions are crucial in determining disease
                                                                         activity and repigmentation. Images were then merged to ob-
This prospective observational study was conducted at the                tain a consolidated image using Adobe Photoshop software
outpatient department of a tertiary care center in India.                (Adobe Inc., version CS3).



Research Letter | Dermatol Pract Concept. 2023;13(3):e2023189 ﻿                                                                        1
Figure 1. (A) Pre-treatment merged dermoscopic image of a patch of vitiligo with no blurring/distortion or missing part (Grade 4) (red-colored
mark denotes 12 o’clock mark or cephalic direction, blue-colored mark denotes 6 o’clock or caudal, green and black marks signify 9 and
3 o’clock or left and right respectively). (B) Merged dermatoscopic image of another patch of vitiligo with blurring but slight (<5%) distor-
tion and missing part <5% limited to central area (Grade 3) (C) Merged dermatoscopic image of another patch of vitiligo with blurring and
distortion more than 5% but less than 10% and missing part <10% limited to central area (Grade 2) (D) Merged dermatoscopic image of
another patch of vitiligo with no distortion but blurring and missing more than 10% (Grade 1).


    The merged images were evaluated by 3 independent inves-             considered for analysis (Table 1). Level of agreement be-
tigators at the end of the study (VK, AB, and AD) and graded             tween the three experts for consolidated mage analyses were
on a Likert scale (Table S1). Consensus was said to be reached           acceptable (Cohn and Fleiss kappa value > 0.6).
for each image if two or more investigators scored equal grades.
Additionally, each investigator also scored the pair of pre- and
                                                                         Conclusions
post-treatment consolidated image of each patient. Cohn
Kappa analysis was performed for two observers and Fleiss                The proposed technique has various advantages like
Kappa assessment was done for more than two observers, with              ease of sequential comparison of dermatoscopic images
level of agreement more than 0.6 considered as significant.              post-treatment, more rapid assessment and reduced digital
    Amongst 120 consolidated images, consensus was not                   space usage in acquisition and storage of dermatoscopic
reached for one image, hence 119 images and 59 pairs were                ­images. Inter observer agreement was significant in majority



2                                                                            Research Letter | Dermatol Pract Concept. 2024;14(1):e2024003﻿
              Table 1. Image quality analysis by three independent dermatoscopy experts (N = 120).
                                               Consolidated Image Analysis (N = 120)a
    Image Quality              Expert 1               Expert 2            Expert 3              Consensus             Fleiss kappa
    Grade 1                         12                      6                   9                7 (5.9%)
    Grade 2                         12                    11                    9                11 (9.2%)
    Grade 3                         19                    20                   19               17 (14.3%)                0.679
    Grade 4                         77                    83                   83               84 (70.6%)
    Total                         120                    120                 120                    119
    Paired image analysis (N = 60)
    Grade 1                        11                      6                   7                 7 (11.9%)
    Grade 2                        07                      6                   7                 6 (10.1%)
    Grade 3                        14                     15                  12                12 (20.3%)                0.770
    Grade 4                        28                     33                  34                34 (57.6%)
    Total                          60                     60                  60                     59
a
One image in consolidated image analysis and one pair in paired image analysis excluded due to lack of consensus amongst three experts.


of instances overall, denoting the reliability and reproduc-            2. Dellatorre G, Gadens GA. Wide area digital dermoscopy.
ibility of this method in follow up of vitiligo.                           J Am Acad Dermatol. 2019;80(6):e153. DOI: 10.1016/j.jaad
                                                                           .2018.12.019. PMID: 30576760.
      However, this method currently has its limitations as well
                                                                        3. Dellatorre G, Gadens GA, Polo Silveira L, Kose K, Marghoob AA.
like difficulty in merging images larger than 6 cm, deterio-
                                                                           Video-based wide area digital dermoscopy. J Am Acad Derma-
ration of quality due to variation in the orientation of the               tol. 2022;87(4):e125-e126. DOI: 10.1016/j.jaad.2021.06.842.
dermatoscope with respect to the anatomical position of the                PMID: 34146617.
body and unprecedented technological limitations, which                 4. Gupta P, Keshavamurthy V, Bishnoi A, Kumaran MS, Parsad D.
warranted manual merging of certain images.                                A prospective observational study to sequentially determine
                                                                           the dermoscopic features of vitiligo and its association with
                                                                           disease activity in patients on medical treatment. Pigment Cell
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Research Letter | Dermatol Pract Concept. 2024;14(1):e2024003 ﻿                                                                         3
