Prediction of response to surgical therapy in nonsegmental vitiligo based on an immunohistochemical cutoff value

Background Objective assessment of stability is still lacking in nonsegmental vitiligo (NSV). Objective To suggest immunohistochemical cutoff values that can predict a good response to surgical therapy of NSV cases. Patients and methods Fifteen active and 15 stable NSV cases were included in the present study. A 3-mm perilesional biopsy from perilesional skin was obtained for immunohistochemical staining for CD8, CD45RO, and FoxP3. Mini punch graft was done for all cases, and response was assessed after 6 months. Good responders had spread of pigment more than 1 mm, and poor responders had no spread of pigment or loss of color. Comparison of immunohistochemical findings according to response to surgery was done, and a cutoff value was calculated when feasible. Results Ten active and 10 stable cases continued 6 months of follow-up. Loss of color occurred in all active cases, whereas five patients had no spread and five patients had good response in the stable group. Good responders had a significantly lower level of CD8+ (P=0.001) and CD45RO+ cells (P=0.020), with cutoff values of 7 and 11 cells/high-power field, respectively. No significant difference was found in FoxP3+ cells. Conclusion A suggested cutoff value of 7 CD8+ T cells and 11 CD45RO+ cells/high-power field can predict a good response to surgery in NSV.