Dr. Neha Virmani

Blaschko's lines also termed as the lines of Blaschko, are believed to represent normal cell development in the skin. This concept was first introduced by the German dermatologist Alfred Blaschko at the 7th Congress of German Dermatological Society in 1901.[1] These lines create a surface pattern which is distinct from other morphological lines of the skin and skin dermatomes. They do not correspond to nervous, muscular, or lymphatic systems.[2] They are invisible under normal conditions and become apparent when some diseases of the skin or mucosa manifest themselves according to these patterns.[1] They follow a “V”-shape over the upper spine, an S-shape on the abdomen, and an inverted U-shape from the breast area over to the upper arm. These are perpendicular down the front and back of the lower extremities.[1] Pictorial view of the distribution of these lines is displayed in [Figure 1a and b]. Because of their linear distribution, historically, these were assumed to represent Koebner's phenomenon, but the curvature of the lesions does not advocate this theory. These are not clearly defined over head and neck. Happle et al.[34] pronounced these lines to the posterior scalp, whereas, Bolognia et al.[5] further reported them over the lateral aspect of the face and neck. Brown and Gorlin introduced vertical striations on the lips, linear midline lesions on the hard and soft palate, and linear unilateral and/or midline bands over the tongue in patients with epidermal nevi. The anatomic equivalent of Blaschko's lines have also been reported over the teeth as well as in the eyes.[6]

BACKGROUND: Vitiligo-affected individuals, especially patients with darker skin tones, can suffer from negative psychosocial impacts due to unpredictable development of the condition and perceived cosmetic concerns. However, given that spontaneous repigmentation can be gained in vitiligo, many patients ask for treatment due to these cosmetic concerns. In the literature, only a few studies have been documented focusing on the outcome of various treatment modalities for vitiligo. OBJECTIVE: This article highlights the retrospective response of various treatment modalities in Indian patients with vitiligo. METHODS: A retrospective chart review was performed from July 2017 to August 2018 at our private dermatology clinic. A total of 3,000 patients were enrolled in this observational study. Patient characteristics and details of phototherapy (psoralen and ultraviolet A, narrow-band ultraviolet B, excimer laser) were noted as per a predefined format. The clinical response was evaluated as a marked response, defined as repigmentation in more than 75% of the initial lesional area. RESULTS: Of those included in this retrospective analysis, 1,996 patients received phototherapy and 1,004 patients were treated with topical monotherapy. Patients treated with phototherapy only and those treated with a combination of phototherapy and topical agents showed significantly higher clinical response rates relative to patients treated with topical monotherapy only (marked response rate: 47.8% vs. 8.7%; P<0.001 and 23.4% vs. 8.7%; P<0.001). Disease subtype predominately affected the treatment response. CONCLUSION: In Indian patients with vitiligo, phototherapy appears to be an effective treatment option for both focal and vitiligo vulgaris. Due to its reliability and minimal side effects, it can be considered a preferable treatment modality for vitiligo.