INSTRUCTIONS FOR USE: Vitiligo Signs of Activity Score (VSAS)

The VSAS is a measure to express the presence of 3 clinical visible signs linked to disease activity in vitiligo: Confetti like depigmentations (C), Koebner phenomenon (K) and Hypochromic areas/borders (H). This tool can be used by physicians in clinical trials and daily practice, preferably with the aid of a Wood’s lamp.

This measurement instrument can generate an overall Vitiligo Signs of Activity Score (VSAS) and 3 subscores (c-VSAS, k-VSAS, h-VSAS). The overall VSAS is based on the presence of at least one visible clinical signs within 15 predefined areas resulting in a score between 0 and 15. A similar score (0-15) can be performed for each clinical sign separately generating the subscores: confetti-like depigmentations (c-VSAS), Koebner phenomenon (k-VSAS) and hypochromic areas/borders (h-VSAS).

STEP 1:
If a clinical visible sign is present one can add/select in each demarcated areas the applicable abbreviation for each sign (C, K, H)

STEP 2:
As an option you can add the most applicable grade for that sign (e.g. C1; C2; C3; K1; K2; K3; H1, H2, H3). The grading reflects an estimation of the intensity of each clinical sign within a specific area and corresponds overall to ‘somewhat present’ (grade 1), ‘clearly present’ (grade 2) or ‘very clearly present’ (grade 3). See chart for grading on the next page as reference material.

STEP 3:
Based on the grading per area, in addition one ‘global grade’* (total body grade) per clinical sign can be assigned, which can be considered as the grade that is most evident on average for a specific clinical sign.

Reference/source:
van Geel N, Passeron T, Wolkerstorfer A, Speeckaert R, Ezzedine K. Reliability and validity of the Vitiligo Signs of Activity Score (VSAS). Br J Dermatol. 2020 Nov;183(5):883-890.

Chart for grading (grade 1–3) the signs included in the Vitiligo Signs of Activity Score (VSAS)

The grading reflects an estimation of the intensity of each clinical sign within a specific area.

For c-VSAS (confetti-like depigmentations) this is the estimated number of confetti-like depigmentations around a representative lesion (grade 1, < 10; grade 2, 10–50; grade 3, > 50).

For k-VSAS (Koebner phenomenon) and h-VSAS (hypochromic areas/borders) this is the presence (estimated number of signs) per demarcated area: grade 1, 1; grade 2, 2–5; grade 3, > 5.

The grades correspond overall to ‘somewhat present’ (grade 1), ‘clearly present’ (grade 2) or ‘very clearly present’ (grade 3).

Based on the grading per area, in addition one ‘global grade’ (total body grade) per sign can be assigned, which can be considered as the grade that is most evident on average for a specific clinical sign.

Reference/source:
van Geel N, Passeron T, Wolkerstorfer A, Speeckaert R, Ezzedine K. Reliability and validity of the Vitiligo Signs of Activity Score (VSAS). Br J Dermatol. 2020 Nov;183(5):883-890.