Centre of Evidence Based Dermatology

Vitiligo Outcome Measures

Understanding how best to measure treatment outcomes (benefits and harms of treatment) is one of our areas of interest. In vitiligo trials, “percentage re-pigmentation” is often used to assess the effectiveness of treatments, but this may not fully capture what is most important to patients, and it is often difficult to measure reliably. An international consensus study recommended that the following things should be measured in future vitiligo trials:

  •  Percentage re-pigmentation
  •  Cosmetic acceptability
  •  Cessation of spread
  •  Quality of life
  •  Maintenance of response
  •  Burden of treatment
  •  Harms

VNS is free to use, but please request permission to use it.

Request permission to use the VNS


Vitiligo Noticeability Scale 

The Vitiligo Noticeability Scale (VNS) was developed as a way of assessing "cosmetic acceptability" of treatment response. It has been designed to be quick and simple to use in both clinical trials and in normal clinical practice.

Wording of the Vitiligo Noticeability Scale (VNS)

"Compared to before treatment, how noticeable is the vitiligo now?

  •  More noticeable (1)
  •  As noticeable (2)
  •  Slightly less noticeable (3)
  •  A lot less noticeable (4)
  • No longer noticeable (5)

The VNS is free to use, but please let us know if you would like to use the scale.

(©The University of Nottingham)


Development of the VNS scale

Details are available of how the VNS was developed and can be viewed here.

The VNS scale is being used as the primary outcome in the HI-light Vitiligo Trial.

Validation of the VNS scale

Initial validation of the scale is promising and has demonstrated that scores on the VNS are more closely associated with overall 'treatment of success' than % re-pigmentation.

Further details are available of how the VNS was validated.

How to interpret the VNS scale

  • VNS score of 1 or 2 = treatment not successful
  • VNS score of 3 = treatment partially successful
  • VNS score of 4 or 5 = treatment successful


As part of World Vitiligo Day (25th June) Dr Eleftheriadou was interviewed by Fox 2 News reporter Lee Thomas. She spoke about how she is working with vitiligo patients on ensuring outcomes capture patients views.


Noticeability of vitiligo is in the eye of the beholder.
Pandya AG, Ezzedine K.
Br J Dermatol. 2022 Jul 29. doi: 10.1111/bjd.21779. Epub ahead of print. PMID: 35905981.

Using the Vitiligo Noticeability Scale in clinical trials: construct validity, interpretability, reliability and acceptability.
Batchelor JM, Gran S, Leighton P, Howells L, Montgomery AA, Tan W, Ahmed I, Thomas KS.
Br J Dermatol. 2022 May 21. doi: 10.1111/bjd.21671. Epub ahead of print.

Time for a patient-oriented outcome in vitiligo: the vitiligo noticeability scale.
Ezzedine K, Pandya A.
Br J Dermatol. 2016 Feb;174(2):255-6. doi: 10.1111/bjd.14378. PMID: 26871913.

Validation of the Vitiligo Noticeability Scale: a patient-reported outcome measure of vitiligo treatment success.
Batchelor JM, Tan W, Tour S, Yong A, Montgomery AA, Thomas KS.
Br J Dermatol
. 2016 Feb;174(2):386-94.

Developing core outcome set for vitiligo clinical trials: international e-Delphi consensus.
Eleftheriadou V, Thomas K, et al.; Vitiligo Global Issues Consensus Group.
Pigment Cell Melanoma Res. 2015 May;28(3):363-9.

Survey and online discussion groups to develop a patient-rated outcome measure on acceptability of treatment response in vitiligo.
Tour SK, Thomas KS, Walker DM, Leighton P, Yong AS, Batchelor JM.
BMC Dermatol. 2014 Jun 14;14:10.

Which outcomes should we measure in vitiligo? Results of a systematic review and a survey among patients and clinicians on outcomes in vitiligo trials.
Eleftheriadou V, Thomas KS, Whitton ME, Batchelor JM, Ravenscroft JC.
Br J Dermatol. 2012 Oct;167(4):804-14.


Centre of Evidence Based Dermatology

The University of Nottingham
Applied Health Research Building
University Park, Nottingham

telephone: +44 (0) 115 84 68631
email: cebd@nottingham.ac.uk