Validation of the diagnostic criteria for segmental vitiligo

Background

Segmental vitiligo has a different clinical course and prognosis as compared to nonsegmental vitiligo, which necessitates its correct diagnosis. It may be difficult to distinguish segmental vitiligo from the limited or focal types of nonsegmental vitiligo.

Objective

To validate the previously proposed diagnostic criteria for segmental vitiligo.

Methods

This was a cross-sectional validation study involving patients with limited vitiligo. The diagnostic criteria were used to classify vitiligo lesions as segmental or nonsegmental, and was compared with the experts' diagnosis, which was considered as the "gold standard".

Results

The study included 200 patients with 225 vitiligo lesions. As per the diagnostic criteria, 146 vitiligo lesions were classified as segmental and 79 as nonsegmental. The experts classified 147 vitiligo lesions as segmental and 39 as nonsegmental, while the diagnosis either was labeled "unsure" or could not be agreed upon for 39 lesions. As compared with the experts' opinions ("for sure" cases, n = 186), the sensitivity and specificity of the diagnostic criteria was 91.8% (95% confidence interval [CI]: 86.2%-95.7%) and 100% (95% CI: 91%-100%), respectively. The positive predictive value was 100% (95% CI: 97.3-100%), while the negative predictive value was 76.5% (95% CI: 62.5%-87.2%). There was a 93.5% agreement between the clinical criteria and experts' opinions (k = 0.83, P < 0.001).

Limitation

The diagnostic criteria were compared with the experts' opinion in the absence of an established diagnostic "gold standard".

Conclusions

The proposed diagnostic criteria for segmental vitiligo performed well, and can be used in clinical practice, as well as in research settings.

A Clinico-epidemilogical Study of Gental Warts

The epidemiological and clinical, characteristics of 109 patients (94 then and 15 women) with gental warts were studied at the STD Training and Denimonstration Centre, Safdarjang Hospital, New Delhi. Genital warts is a disease of young adults and correlates with sexual maturity. The majority of patients were poor socio-economically, non-promiscuous and not addicted to alcohool. Most of the with the disease, were single and the women . married, reflecting the differing sources of acquisition of the disease. Homosexuality played a significant role in the acquisition of perianal warts in males. The mean incubation period. Warts were more numerous in women.. Long foreskins, by presenting a more moist environment probably preispose to the acquisition and propagation of warts. Personal hygiene soon after coitus did not seem significant, in the prevention of warts Cutaneous warts were associated in 8% of the cases. Concomitant sexually transmitted infections were present in 38.5% of the patients. Genital warts showed a preferential distribution at sites frequently subjected to the trauma of coitus.

A Study of Behavioural Aspects of Sexually Transmitted Diseases

Some of the behaaoural aspects of 227 randomly selected male,patients attending the STD ClWc of Safung Hospitak New were The majority were below thirty years of age and poorly educated. Two thirds -of the patients were teetotalers .37.4% study group were pronuscuous and 353% of the group were repwcrs' A high of pre-marital sex was noted. 352% of the stated their spouse to be the cause of the StD. 11.9% of the study group admittc to homosexuality. Professional women (prostitutes and call girls) were the source of the majority of infections-. There was a statistically significant relationship between consumption of alcohol and promiscuity. Now of the major STDS. was significantly Mort frequently acquired from any particular source. NSU however was more frequent amongthchom . Such studies should be conducted from time to time to understand and evaluate the trend of permissiveness in the society.

Psoriasis and Diabetes Millitus

Twenty uncomplicated cases of psoriasis and an equal number of matched controls were evaluated using the oral and steroid primed glucose tolerance test. Six of the twenty psoriatics (30%) studied showed an abnormal glucose tolerancewhereas only one of the twenty control subjects (5 %) showed abnormality (p < 0.05). A relationship was found between abnormal glucose tolerance and surface area involved by psoriasis.