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como un &#237;ndice que mide la rapidez de diseminaci&#243;n del vit&#237;ligo no segmentario &#40;VNS&#41; para ser utilizado como referencia&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">En el Centro Dermatol&#243;gico Dr&#46; Ladislao de la Pascua se realiz&#243; un estudio transversal&#46; Se incluyeron pacientes de 18 a&#241;os y m&#225;s&#44; con VNS diagnosticado por un dermat&#243;logo&#46; Firmaron consentimiento informado&#46; La SCA se midi&#243; con VES y la TP se obtuvo al dividir el porcentaje de SCA por los a&#241;os vividos con vit&#237;ligo&#58; TP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#37;SCA&#47;&#40;a&#241;os con vit&#237;ligo&#41;&#59; la TPajustada&#58; TP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#37;SCA&#47;&#40;a&#241;os con vit&#237;ligo-periodo sin progresi&#243;n&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se pregunt&#243;&#58; &#171;Desde que comenz&#243; con vit&#237;ligo hasta la fecha&#44; &#191;ha tenido alg&#250;n periodo de tiempo sin que aumentara el tama&#241;o las manchas blancas o aparecieran nuevas&#63;&#187; Se pidi&#243; recordar el tiempo aproximado y si fue m&#225;s de un per&#237;odo se apoy&#243; para cuantificar el tiempo total&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El comit&#233; de investigaci&#243;n y &#233;tica aprob&#243; el protocolo de investigaci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Participaron 492 pacientes&#44; con 45&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 a&#241;os de edad y fototipo <span class="elsevierStyleSmallCaps">iii</span> y <span class="elsevierStyleSmallCaps">iv</span> en el 86&#37;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La rapidez de la progresi&#243;n se categoriz&#243; en&#58; &#171;lenta&#187;&#44; &#171;moderada&#187; y &#171;r&#225;pida&#187; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> y <a class="elsevierStyleCrossRef" href="#sec0035">en la tabla S1 del material suplementario</a> se presenta la SCA y TP estratificada por el tiempo de evoluci&#243;n y la edad&#46; El 16&#37; refirieron periodos sin progresi&#243;n&#44; se calcul&#243; la TPajustada descontando ese periodo de tiempo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">La correlaci&#243;n de la edad&#44; la edad de inicio&#44; el tiempo de evoluci&#243;n&#44; SCA y TP fueron significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0035">tabla 2 y fig&#46; 1 del material suplementario</a>&#41;&#46; La correlaci&#243;n entre el tiempo de evoluci&#243;n con la SCA fue 0&#44;32 p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 y con la TP -0&#44;30 p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 &#40;<a class="elsevierStyleCrossRef" href="#sec0035">figs&#46; 2 y 3 del material suplementario</a>&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Conocer el curso cl&#237;nico permite establecer el pron&#243;stico&#46; La evoluci&#243;n del VNS se define como impredecible<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#58; &#171;generalmente&#187; la piel se afecta de manera lenta&#44; pero progresiva&#44; durante toda la vida&#44; aunque &#171;algunos&#187; pueden tener r&#225;pida progresi&#243;n&#44; permanecer sin cambios durante a&#241;os y &#171;pocos&#187; llegan a un vit&#237;ligo universal&#46; Se desconoce si la respuesta al tratamiento cambia con el tiempo de evoluci&#243;n o el da&#241;o acumulado&#44; y si el tratamiento disminuye la rapidez de la diseminaci&#243;n a largo plazo&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La TP puede ser una herramienta para obtener datos que ayuden a responder estas interrogantes<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; El 24&#37; de los pacientes estudiados tuvo una progresi&#243;n lenta&#44; el 51&#37; moderada y el 25&#37; r&#225;pida &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A trav&#233;s del tiempo se incrementa el da&#241;o acumulado&#44; 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sin embargo&#44; de acuerdo con F&#233;rez-Blando el paciente no olvida cu&#225;ndo inici&#243; la enfermedad y c&#243;mo ha evolucionado<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46; El impacto de la peque&#241;a proporci&#243;n de pacientes con periodos sin progresi&#243;n en el c&#225;lculo de la TP fue discreto &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El tiempo de evoluci&#243;n explica el 10&#37; de la variaci&#243;n de la SCA y el 9&#37; de la rapidez de la progresi&#243;n &#40;<a class="elsevierStyleCrossRef" href="#sec0035">tabla 2 y fig&#46; 3 del material suplementario</a>&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Fue posible observar la magnitud y direcci&#243;n de las correlaciones entre las variables&#44; destacando que solo la relaci&#243;n entre la edad del paciente y la rapidez de la progresi&#243;n carece de significaci&#243;n estad&#237;stica &#40;<a class="elsevierStyleCrossRef" href="#sec0035">tabla 2 y fig&#46; 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Carta científico-clínica
Evaluación cuantitativa de la rapidez de la progresión en pacientes con vitíligo e implicaciones en el pronóstico
Quantification of the Progression Rate in Vitiligo and Prognostic Implications
M.L. Peralta-Pedreroa,b,
Corresponding author
luisa.peraltap@gmail.com

Autor para correspondencia.
, M.A. Morales-Sáncheza, A. Cruz-Peraltab, G. Guerrero-Olivaa,b
a Centro Dermatológico Dr. Ladislao de la Pascua, Ciudad de México, México
b Universidad Nacional Autónoma de México, Ciudad de México, México
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como un &#237;ndice que mide la rapidez de diseminaci&#243;n del vit&#237;ligo no segmentario &#40;VNS&#41; para ser utilizado como referencia&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">En el Centro Dermatol&#243;gico Dr&#46; Ladislao de la Pascua se realiz&#243; un estudio transversal&#46; Se incluyeron pacientes de 18 a&#241;os y m&#225;s&#44; con VNS diagnosticado por un dermat&#243;logo&#46; Firmaron consentimiento informado&#46; La SCA se midi&#243; con VES y la TP se obtuvo al dividir el porcentaje de SCA por los a&#241;os vividos con vit&#237;ligo&#58; TP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#37;SCA&#47;&#40;a&#241;os con vit&#237;ligo&#41;&#59; la TPajustada&#58; TP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#37;SCA&#47;&#40;a&#241;os con vit&#237;ligo-periodo sin progresi&#243;n&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se pregunt&#243;&#58; &#171;Desde que comenz&#243; con vit&#237;ligo hasta la fecha&#44; &#191;ha tenido alg&#250;n periodo de tiempo sin que aumentara el tama&#241;o las manchas blancas o aparecieran nuevas&#63;&#187; Se pidi&#243; recordar el tiempo aproximado y si fue m&#225;s de un per&#237;odo se apoy&#243; para cuantificar el tiempo total&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El comit&#233; de investigaci&#243;n y &#233;tica aprob&#243; el protocolo de investigaci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Participaron 492 pacientes&#44; con 45&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 a&#241;os de edad y fototipo <span class="elsevierStyleSmallCaps">iii</span> y <span class="elsevierStyleSmallCaps">iv</span> en el 86&#37;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La rapidez de la progresi&#243;n se categoriz&#243; en&#58; &#171;lenta&#187;&#44; &#171;moderada&#187; y &#171;r&#225;pida&#187; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> y <a class="elsevierStyleCrossRef" href="#sec0035">en la tabla S1 del material suplementario</a> se presenta la SCA y TP estratificada por el tiempo de evoluci&#243;n y la edad&#46; El 16&#37; refirieron periodos sin progresi&#243;n&#44; se calcul&#243; la TPajustada descontando ese periodo de tiempo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">La correlaci&#243;n de la edad&#44; la edad de inicio&#44; el tiempo de evoluci&#243;n&#44; SCA y TP fueron significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0035">tabla 2 y fig&#46; 1 del material suplementario</a>&#41;&#46; La correlaci&#243;n entre el tiempo de evoluci&#243;n con la SCA fue 0&#44;32 p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 y con la TP -0&#44;30 p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 &#40;<a class="elsevierStyleCrossRef" href="#sec0035">figs&#46; 2 y 3 del material suplementario</a>&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Conocer el curso cl&#237;nico permite establecer el pron&#243;stico&#46; La evoluci&#243;n del VNS se define como impredecible<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#58; &#171;generalmente&#187; la piel se afecta de manera lenta&#44; pero progresiva&#44; durante toda la vida&#44; aunque &#171;algunos&#187; pueden tener r&#225;pida progresi&#243;n&#44; permanecer sin cambios durante a&#241;os y &#171;pocos&#187; llegan a un vit&#237;ligo universal&#46; Se desconoce si la respuesta al tratamiento cambia con el tiempo de evoluci&#243;n o el da&#241;o acumulado&#44; y si el tratamiento disminuye la rapidez de la diseminaci&#243;n a largo plazo&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La TP puede ser una herramienta para obtener datos que ayuden a responder estas interrogantes<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; El 24&#37; de los pacientes estudiados tuvo una progresi&#243;n lenta&#44; el 51&#37; moderada y el 25&#37; r&#225;pida &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A trav&#233;s del tiempo se incrementa el da&#241;o acumulado&#44; pero la rapidez de la progresi&#243;n se enlentece &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Esto puede explicar la baja prevalencia del vit&#237;ligo universal&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Con los datos obtenidos podemos suponer que en el 50&#37; de los pacientes&#44; similares a los de la muestra&#44; se podr&#237;a esperar una progresi&#243;n menor a 0&#44;2&#37; por a&#241;o&#44; y en el 90&#37; el incremento no rebasar&#225; el 2&#37; por a&#241;o&#46; En cuanto al da&#241;o acumulado el 50&#37; ser&#225; menor del 0&#44;6&#37; de SCA y en el 90&#37; no llegar&#225; a afectar m&#225;s del 9&#37; SCA explicando la baja prevalencia del vit&#237;ligo universal&#44; que se estima entre el 0&#44;39&#37; y el 6&#44;2&#37;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> &#40;<a class="elsevierStyleCrossRef" href="#sec0035">fig&#46; 2 del material suplementario</a>&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los datos que aporta el paciente son subjetivos&#59; sin embargo&#44; de acuerdo con F&#233;rez-Blando el paciente no olvida cu&#225;ndo inici&#243; la enfermedad y c&#243;mo ha evolucionado<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46; El impacto de la peque&#241;a proporci&#243;n de pacientes con periodos sin progresi&#243;n en el c&#225;lculo de la TP fue discreto &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El tiempo de evoluci&#243;n explica el 10&#37; de la variaci&#243;n de la SCA y el 9&#37; de la rapidez de la progresi&#243;n &#40;<a class="elsevierStyleCrossRef" href="#sec0035">tabla 2 y fig&#46; 3 del material suplementario</a>&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Fue posible observar la magnitud y direcci&#243;n de las correlaciones entre las variables&#44; destacando que solo la relaci&#243;n entre la edad del paciente y la rapidez de la progresi&#243;n carece de significaci&#243;n estad&#237;stica &#40;<a class="elsevierStyleCrossRef" href="#sec0035">tabla 2 y fig&#46; 1 del material suplementario</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La rapidez de progresi&#243;n de la enfermedad probablemente refleje la agresividad de la respuesta autoinmune&#46; La edad y el g&#233;nero no influyen en la TP&#44; y es probable que a mayor edad de inicio&#44; mayor sea la tasa de progresi&#243;n&#44; y que a mayor tiempo de evoluci&#243;n disminuya la tasa de progresi&#243;n&#44; o que la enfermedad tenga una progresi&#243;n m&#225;s r&#225;pida al inicio independientemente de la edad&#46; Faltan estudios de factores pron&#243;sticos para constatar estos hallazgos&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El estudio tiene algunas limitaciones&#58; el dise&#241;o transversal&#44; aunque representa una buena alternativa frente a la dificultad de desarrollar grandes estudios prospectivos longitudinales&#44; que ser&#237;an ideales&#46; Por otra parte&#44; la tasa de progresi&#243;n cuantifica la rapidez de la evoluci&#243;n de manera uniforme a trav&#233;s del tiempo&#44; pero debe considerarse solo como una estimaci&#243;n global en el momento de la evaluaci&#243;n&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicto de intereses</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de caracter&#237;sticas cl&#237;nicas de los pacientes con vit&#237;ligo no segmentario de acuerdo a la rapidez de la progresi&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>492&#41;</p>"
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ISSN: 00017310
Original language: Spanish
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