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.
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
- 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
- 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
- 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
- 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
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