Md. Njoo et al., Association of the Kobner phenomenon with disease activity and therapeuticresponsiveness in vitiligo vulgaris, ARCH DERMAT, 135(4), 1999, pp. 407-413
Objective: To investigate the association between the experimentally induce
d Kobner phenomenon (KP-e) and the Kobner phenomenon by history (KP-h), dis
ease 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 i
nduced, the KP-e was evaluated. For 1 year, UV-B (311 nm) therapy or topica
l fluticasone propionate plus UV-A therapy was given, depending on the seve
rity of depigmentation.
Main Outcome Measures: The presence or absence of the KP-e and the KP-h dis
ease 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 VID
A score (VIDA score of 1.6) than did patients with a negative KP-e (VIDA sc
ore of 0.5) (P<.001). The responsiveness to W-B (311 nm) therapy among KP-e
-positive or KP-e-negative patients was not significantly different (P = .6
6) However, KP-e-positive patients who were treated with fluticasone propio
nate plus UV-A showed a better response than did KP-e-negative patients (P
= .01). Among patients responding to both therapies, VIDA scores were signi
ficantly decreased (P<.001) compared with VIDA scores before therapy.
Conclusion: The KP-e may function well as a clinical factor to assess prese
nt disease activity and may also predict the responsiveness to fluticasone
propionate plus W-A therapy but not to UV-B (311 nm) therapy.