Heal House Vitiligo Research 24 · Original Article
Is there a way to precisely measure how much vitiligo treatment has improved?
Development and validation of the Vitiligo Extent Score for a Target Area (VESTA) to assess the treatment response of a target lesion
In short
VESTA is an assessment tool designed to accurately measure how much color has returned after treatment. When used by specialists, it proved more accurate and consistent than visual estimation.
When treating vitiligo, we often face the question, "How much has it improved since last time?" Existing scores that measure the whole body did exist. However, there was no suitable tool to accurately measure how much color a specific area of interest had regained. Each doctor's visual estimation differed slightly, so evaluations of the same photo often varied. Therefore, we decided to create an objective ruler that would give similar results regardless of who used it. This is how VESTA was developed.
Q1 Why is it hard to measure treatment progress, and what is VESTA?
Because judging how much color has returned by visual estimation can vary slightly from doctor to doctor. Vitiligo treatment takes several months. Therefore, accurately measuring how much improvement has occurred since the last visit is very important for determining the treatment direction. While there were existing tools that measure the whole body, there was no suitable ruler to precisely measure changes in a specific area of interest. VESTA provides "reference images" that show pigment returning from the edges and in spots around hair follicles. By simply comparing with these images, anyone can assign a similar percentage. It requires no complex equipment, making it convenient to use in the clinic.
Q2 Was VESTA really more accurate than the naked eye?
Yes. When validated by multiple specialists, VESTA was more accurate and consistent than visual estimation. 65 board-certified dermatologists from 10 institutions evaluated 17 pairs of vitiligo photos (before and after treatment) using both VESTA and conventional visual estimation, and the results were compared. The VESTA measurements scored 0.949 on a measure of how close they were to the true value, while visual estimation scored 0.896. The closer this score is to 1, the closer it is to the true answer. A score of 0.949 can be read as "nearly perfect agreement." The fact that multiple doctors obtained similar results shows that VESTA is a tool that can be trusted in both research and clinical practice.
Accuracy comparison between VESTA and visual estimation (concordance)
| Assessment method | Concordance (CCC) | In simple terms |
|---|---|---|
| VESTA | 0.949 | Nearly perfect agreement |
| Visual estimation (eyeballing) | 0.896 | Relatively accurate but less consistent |
Closing remarks
Thanks to this, we can now answer the question "Has it really improved since last time?" with numbers rather than just a feeling. The results remain consistent even when different people do the measurement. Therefore, it is useful both in research for fairly comparing treatment effects and in the clinic when reviewing progress with patients. Using this tool, we often realize that a well-made ruler can clarify the direction of treatment. It is also meaningful that the tool was developed in collaboration with researchers from multiple countries.
