Centre for Medical and Surgical Dermatology
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Vitiligo Area Scoring Index

Physician-Reported Clinical Assessment

A quantitative clinical tool for evaluating vitiligo parametrically, using hand-unit area estimation and residual depigmentation grading across five body regions. The total body VASI (T-VASI) represents the sum across all regions.

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About the VASI

Clinical Background

The Vitiligo Area Scoring Index (VASI) is a quantitative clinical tool developed to evaluate vitiligo parametrically, analogous to the PASI for psoriasis. The body is divided into five regions: hands, upper extremities (excluding hands), trunk, lower extremities (excluding feet), and feet. The area of vitiligo in each region is estimated using the hand-unit method, where one hand unit (palm plus volar surface of all digits) equals approximately 1% of total body surface area.

For each body region, the VASI is calculated as: Hand Units of involvement multiplied by Residual Depigmentation grade. Residual depigmentation is graded on a scale from 0% (normal skin) through 10% (specks of depigmentation only), 25%, 50%, 75%, 90%, to 100% (complete depigmentation). The Total Body VASI (T-VASI) is the sum across all body regions, with a score range of 0 to 100.

T-VASI reliability has been confirmed in the TRuE-V phase 3 studies of ruxolitinib cream (ICC: 0.945 between screening and baseline). A minimum 50% improvement in T-VASI from baseline has been identified as a within-patient meaningful threshold.

References

  1. Hamzavi I, Jain H, McLean D, Shapiro J, Zeng H, Lui H. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: the Vitiligo Area Scoring Index. Arch Dermatol. 2004;140(6):677-683. doi:10.1001/archderm.140.6.677
  2. Komen L, da Graca V, Wolkerstorfer A, et al.. Vitiligo Area Scoring Index and Vitiligo European Task Force assessment: reliable and responsive instruments to measure the degree of depigmentation in vitiligo. Br J Dermatol. 2015;172(2):437-443. doi:10.1111/bjd.13432
  3. Bibeau K, Butler K, Wang M, Skaltsa K, Hamzavi IH. Psychometric evaluation of the facial and total Vitiligo Area Scoring Index instruments in the TRuE-V Phase 3 Studies. Dermatol Ther (Heidelb). 2024;14(8):2223-2234. doi:10.1007/s13555-024-01223-y
  4. Kitchen H, Wyrwich KW, Carmichael C, et al.. Meaningful changes in what matters to individuals with vitiligo: content validity and meaningful change thresholds of the VASI. Dermatol Ther (Heidelb). 2022;12(7):1623-1637. doi:10.1007/s13555-022-00752-8

Frequently Asked Questions about the VASI

The Vitiligo Area Scoring Index (VASI) is a quantitative clinical tool developed to evaluate vitiligo parametrically, analogous to the PASI for psoriasis. The body is divided into five regions: hands, upper extremities (excluding hands), trunk, lower extremities (excluding feet), and feet. The Total Body VASI (T-VASI) represents the sum across all body regions, with a score range of 0 to 100.
For each body region, the VASI is calculated as the number of hand units of involvement multiplied by the residual depigmentation grade. One hand unit (palm plus volar surface of all digits) equals approximately 1% of total body surface area. Residual depigmentation is graded on a scale from 0% (normal skin) through 10%, 25%, 50%, 75%, 90%, to 100% (complete depigmentation). The Total Body VASI is the sum across all five body regions.
A VASI score of 0 indicates no vitiligo involvement, while higher scores reflect greater extent and completeness of depigmentation. A minimum 50% improvement in T-VASI from baseline has been identified as a within-patient meaningful threshold. The T-VASI has demonstrated excellent test-retest reliability (ICC: 0.945 between screening and baseline) in the TRuE-V phase 3 studies.

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