Somesh Gupta

Background: The 2015 core domain set (CDS) for vitiligo defines outcomes for clinical trials, comprising three essential and four recommended outcome domains/domain items. Periodic reassessment is required to ensure its continued relevance. Objectives: To evaluate the content validity (relevance, comprehensiveness and comprehensibility) of the 2015 vitiligo CDS to inform a consensus-based update as part of a core outcome set, including core outcomes and core measurement instruments. Methods: A roundtable discussion and three surveys reassessed the 2015 vitiligo CDS regarding relevance (≥ 70% agreement for ‘essential’), comprehensiveness (identification of missing domain items) and comprehensibility (clarity of terminology and descriptions). Results: Fifty-three patients with vitiligo (group 1) and 37 experts (36 dermatologists and 1 researcher; group 2) participated. Two previously essential domains (‘Repigmentation’ and ‘Side effects/harms’) were re-endorsed as essential by both groups. ‘Maintenance of gained repigmentation’ was rated essential by patients only. Among previously recommended domains, ‘Quality of life’ was considered essential by both groups, whereas ‘Cosmetic acceptability of repigmentation’ and ‘Cessation of spreading of vitiligo’ were rated essential by patients only. ‘Tolerability/burden of treatment’ was not considered essential by either group. Frequently suggested missing items (outcomes and contextual factors) included psychological impact, treatment session duration, overall treatment duration, treatment costs, patient education and evaluation of associated auto­immune diseases. Proposed updates included refining domain terminology (e.g. vitiligo-specific/health-related quality of life; replacing ‘harms’ with ‘adverse events’) and addressing feasibility-related timeframes. Conclusions: While the 2015 vitiligo CDS retains content validity for several domains, meaningful updates are warranted. These findings will inform the development of a revised and updated CDS.

Artificial intelligence (AI) systems, particularly deep learning models, are increasingly used in dermatology for image analysis, triage, remote monitoring, and decision support. For real-world adoption in the Indian dermatology ecosystem, robust validation, transparency, and governance are essential to protect patient safety and equity. This position statement synthesizes guidance from international dermatology societies and major regulatory approaches, and proposes India-adapted recommendations across clinical use, dataset curation, validation standards, ethics, privacy, liability, and policy. We performed a narrative synthesis of position statements from the American Academy of Dermatology (AAD), European Academy of Dermatology and Venereology (EADV), British Association of Dermatologists (BAD), and Australasian College of Dermatologists (ACD); regulatory frameworks, including the European Union Medical Device Regulation (EU MDR), the United States Food and Drug Administration (US FDA) Software as a Medical Device (SaMD) approach, National Institute for Health and Care Excellence (NICE) evidence standards, and Australia’s Therapeutic Goods Administration (TGA). Indian frameworks, including the Central Drugs Standard Control Organisation (CDSCO) Medical Device Rules, Bureau of Indian Standards/International Organization for Standardization (BIS/ISO) standards, the Digital Personal Data Protection (DPDP) Act, and Indian Council of Medical Research (ICMR) artificial intelligence ethics guidance were included. Seven domains were analyzed: governance, evidence generation, data bias, clinical safety, privacy, liability, and education. Principles emphasize clinician-in-the-loop use, prospective multicentric validation in representative Indian settings, skin-of-color inclusivity, transparent labeling and explainability, post-market surveillance, and clearer accountability. While clinical utility and health-economic evidence remain limited, validated and inclusive AI tools can responsibly expand access to quality dermatologic care in India, particularly in underserved areas.

Lip-to-lip micropunch grafting: A scarless, seamless solution for lip vitiligo

Vitiligo is a multifaceted autoimmune skin disease characterized by the loss of epidermal melanocytes, yet its molecular basis remains poorly understood. To address the need for a specialized systems biology interface, we present VIRdb v3.0, an integrative database combining curated transcriptomics-based datasets with differentially expressed genes, a protein–protein interaction network highlighting regulatory hubs, and an enriched library of natural compounds and FDA-approved drugs targeting vitiligo-related proteins. The platform supports pathway enrichment, molecular docking, and cross-disease comparisons with autoimmune disorders to identify shared molecular signatures. Backend redevelopment using the Django framework enables scalability and real-time data integration. The updated platform now also supports z-score normalization of expression data, multi-gene pathway enrichment queries, and comparative gene–gene interaction networks for vitiligo and its comorbid autoimmune conditions. VIRdb v3.0 facilitates hypothesis generation, biomarker discovery, and therapeutic exploration, advancing vitiligo systems biology. The database is freely accessible at https://virdb.sbdaresearch.in/.

Background: Non-segmental vitiligo(NSV) shows marked heterogeneity in activity, progression, and treatment response. Reliable clinical markers that predict prognosis and patient-reported outcomes are lacking. Objectives: To identify clinicodemographic and clinical predictors of disease extent, progression, repigmentation, treatment dependency, noticeability, and psychosocial impact in NSV. Methods: In this prospective cohort study, 275 patients with NSV were followed for 12 months. Sixteen baseline variables, including demographic features, autoimmune history, and clinical markers (koebnerization, confetti and trichrome patterns, leukotrichia, mucosal, acral, and periorificial involvement), were recorded. Outcomes included body surface area(BSA), progression, repigmentation, treatment dependency, Vitiligo Noticeability Scale(VNS), and quality-of-life indices(VIS-22, DLQI, C-DLQI, F-VIS). Multivariable analyses and cluster analysis were performed at 6 and 12 months. Results: Markers of disease activity leukotrichia, trichrome and confetti lesions, koebnerization, and mucosal, acral, and periorificial involvement were strongly associated with greater BSA, poor repigmentation, higher noticeability, and treatment dependency. Leukotrichia was consistent predictor of poor repigmentation and high VNS. Family history of autoimmunity predicted progression and treatment dependency. Early-onset vitiligo showed lower disease extent but greater family-related psychosocial burden. Cluster analysis identified severe, intermediate, and mild phenotypes with distinct therapeutic responses. Conclusions: Simple clinical markers can stratify NSV patients into prognostic subgroups, enabling individualized treatment and counseling. Plain Language Summary: Vitiligo behave variably in different people, some people may have slow-spreading course, while others develop widespread or persistent patches. In this study, we followed 275 people with non-segmental vitiligo for one year to find signs on the skin that could predict how the disease would behave and how it would affect daily life. We found that features such as white hair within patches (leukotrichia), speckled (confetti) or three-colored lesions (trichrome), new patches appearing after injury (koebnerization), and involvement of the lips, mouth, hands, feet were linked to more severe disease, poorer response to treatment, and greater cosmetic concern. A family history of autoimmune disease increased the risk of worsening vitiligo. Patients who developed vitiligo early in life had less skin involvement but greater emotional and family-related impact. These easily recognized signs can help doctors and patients plan treatment and set realistic expectations. Significance of the study: Non-segmental vitiligo (NSV) has a heterogeneous and unpredictable clinical course with variable progression and response to therapy. However, robust prospective data linking these markers with long-term outcomes and patient-reported measures remain limited. In our prospective cohort of 275 patients, clinical markers such as leukotrichia, trichrome and confetti lesions, koebnerization, and acral/mucosal/periorificial involvement, were strongly associated with greater disease extent, poorer repigmentation, higher treatment dependency, and increased noticeability. Leukotrichia consistently predicted poor repigmentation. Thereby, prognostic stratification can also improve patient counselling regarding expected repigmentation, treatment duration, and psychosocial burden.

Background: Radiofrequency tissue volume reduction leads to protein denaturation and necrosis of connective tissue, resulting in scarring followed by retraction of soft tissue. Aim: To study the efficacy and safety of intralesional corticosteroids alone versus radioporation-assisted delivery of topical application of triamcinolone acetonide. Methods: A single-centre, randomised, non-blinded study included 31 patients (18-65 years), each with at least two comparable keloids. Patients were randomised (1:1) to receive either intralesional corticosteroid or radioporation-assisted topical corticosteroid for five sessions at 3-week interval, with follow-up at 18 and 24 weeks. Results: The Vancouver Scar Scale (VSS) scores improved in both groups, but the radioporation group showed greater reductions in VSS (mean difference +1.21, p = 0.002), vascularity, pigmentation, pliability, and scar height, despite higher baseline values. Limitations: Short follow-up precluded relapse assessment. Conclusion: Both modalities significantly improved keloids, but radioporation-assisted corticosteroid delivery demonstrated superior efficacy with comparable safety.

Digital dermatology, which is defined as the use of digital technologies that leverage individual- and population-level skin data to improve the diagnosis, treatment, and prevention of skin diseases, has emerged as a critical frontier for bridging persistent gaps in dermatologic care. This transformation holds particular promise for addressing long-standing inequities linked to geography, income, and skin type. According to the Global Burden of Disease 2023 study, skin and subcutaneous diseases remain among the most prevalent global health conditions, contributing substantially to disability-adjusted life years. Digital tools (including teledermatology, artificial intelligence [AI], and large language models) offer new ways to extend diagnosis, education, and patient empowerment to historically underserved populations. However, these same innovations risk amplifying disparities if they are not designed and deployed intentionally. Algorithmic bias, uneven digital access, and the absence of culturally responsive models can undermine progress. In this conceptual and narrative review, we draw on expert dialogues and illustrative literature, including multistakeholder exchanges at the Skin and Digital Summit (2023-2025 ) and related global forums, to examine how digital dermatology can promote equitable skin health. We focus on 3 interlinked priorities: expanding access through scalable digital platforms, ensuring AI fairness via comprehensive and diverse datasets, and countering dermatological misinformation. Central to the latter is a bot concept described here as a dynamic cycle that analyzes scientific literature; ranks evidence; translates complex research into clear language; and delivers trustworthy, personalized guidance to both consumers and clinicians. By embedding expert oversight and evidence prioritization, such tools can ensure that accurate, actionable information reaches users at the speed and scale of the internet. Drawing on case studies (including lessons from the World Health Organization’s AI skin health app) and insights from the Skin and Digital Summit , we highlight both the transformative potential and the ethical complexities of these digital solutions. To navigate this evolving landscape, we propose the concept of radical dermatology , which confronts the reality that big tech is reshaping skin health whether we like it or not and insists that dermatologists and stakeholders lead the transformation through bold collaboration and unwavering clinical relevance.