An objective assessment of melanin in vitiligo skin treated with Balneo PUVA therapy

Abstract

Background: Visual clinical methods of skin color evaluation for diagnostic purposes are so far mostly subjective and thus inaccurate. We present a modified method of melanin amount measurement based on diffuse reflectance spectroscopy (DRS). This method is non-invasive and objective, and allows easy quantification and comparison of melanin levels.

Material and methods: Skin pigmentation was measured by DRS method in 0-18 year old patients at the Department of Pediatric Dermatovenerology, School of Medicine Comenius University Bratislava. Patients were treated for their vitiligo by Balneo PUVA treatment twice weekly. Each patient had measured his remittance spectra from the treated vitiliginous skin before the treatment was started, after 10 irradiations of Balneo PUVA and at the end of the treatment after 25 irradiations of Balneo PUVA. In our study as a reference skin for spectroscopic assessment of melanin in vivo was used the averaged remittance spectra (measured on the inner arm) from the sample of 10 albino patients. The remittance spectra obtained from the vitiligo patients were ratioed against the newly described remittance reference albino skin. We exploited the linear behavior of the spectral curve in the 620-720 nm interval (significant for melanin absorption) and used the slope of the regression line to compute the quantification index α.

Results: By clinical examination before the Balneo PUVA therapy, after the 10th dose of Balneo PUVA therapy as well as at the end of the complete course of Balneo PUVA therapy (after 25 irradiations) we recorded a marked increase of pigmentation in all treated patients for their vitiligo. In each patient the values of melanin quantification angle α were calculated. Statistically we found a significant difference between the melanin quantification angle α in vitiliginous skin before, during the 10th dose of treatment and after the treatment. Similar significant difference was also observed between treated and non-involved skin. We could confirm a clear association between clinical visual examination of treated vitiligo lesions, objective data collected by DRS and melanin quantification angle α.

Conclusions: By using a new standard for the reference skin (albino skin) we could more exactly compare melanin levels in different subjects. Our proposed melanin quantification angle α expresses the extent of the difference in melanin levels between the examined skin lesions. We successfully used this index to quantify the variations of melanin (progress of repigmentation) throughout different stages of treatment of the same lesion and also to objectively evaluate the final effect of the therapy. In the present study, we showed that the diffuse reflectance spectroscopy (DRS) may be suitable method to measure skin colour and the content of human skin melanin in vivo.

Keywords: diffuse reflectance spectroscopy; melanin in vivo.; melanin index; quantification of skin melanin; vitiligo assessment.