GENERAL DERMATOLOGY BJD British Journal of Dermatology Validation of the Vitiligo Noticeability Scale: a patient- reported outcome measure of vitiligo treatment success* J.M. Batchelor, 1 W. Tan, 2 S. Tour, 1 A. Yong, 3 A.A. Montgomery 2 and K.S. Thomas 1 1 Centre of Evidence Based Dermatology, King’s Meadow Campus, Lenton Lane, Nottingham NG7 2NR, U.K. 2 Nottingham Clinical Trials Unit, Queen’s Medical Centre, C Floor, South Block, Nottingham NG7 2UH, U.K. 3 Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, U.K. Correspondence Jonathan M. Batchelor. E-mail: jonathan.batchelor@nottingham.ac.uk Accepted for publication 23 September 2015 Funding sources This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number 12/24/ 02). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Health Technology Assessment pro- gramme, NIHR, National Health Service or the Department of Health. Conflicts of interest None declared. *Plain language summary available online DOI 10.1111/bjd.14208 Summary Background Patient-reported outcome measures are rarely used in vitiligo trials. The Vitiligo Noticeability Scale (VNS) is a new patient-reported outcome measure assessing how ‘noticeable’ vitiligo patches are after treatment. The noticeability of vitiligo after treatment is an important indicator of treatment success from the patient’s perspective. Objectives To evaluate the construct validity, acceptability and interpretability of the VNS. Methods Clinicians (n = 33) and patients with vitiligo (n = 101) examined 39 image pairs, each depicting a vitiligo lesion pre- and post-treatment. Using an online questionnaire, respondents gave a global assessment of treatment success and a VNS score for treatment response. Clinicians also estimated percentage repigmentation of lesions (< 25%; 25–50%; 51–75%; > 75%). Treatment success was defined as ‘yes’ on global assessment, a VNS score of 4 or 5, and > 75% repigmentation. Agreement between respondents and the different scales was assessed using kappa (j) statistics. Results Vitiligo Noticeability Scale scores were associated with both patient- and clinician-reported global treatment success (j = 0Á54 and j = 0Á47, respec- tively). Percentage repigmentation showed a weaker association with patient- and clinician-reported global treatment success (j = 0Á39 and j = 0Á29, respec- tively). VNS scores of 4 or 5 can be interpreted as representing treatment success. Images depicting post-treatment hyperpigmentation were less likely to be rated as successful. Conclusions The VNS is a valid patient-reported measure of vitiligo treatment suc- cess. Further validation of the VNS is required, using larger sets of clinical pre- and post-treatment images, affecting a wider range of anatomical sites. What’s already known about this topic? • The lack of standardized outcome measures makes comparison of vitiligo treatment efficacy difficult. • Patient-reported outcome measures are rarely used in vitiligo trials. • Patient-reported outcome measures assessing vitiligo treatment success from the patient’s perspective have yet to be developed. • The Vitiligo Noticeability Scale (VNS) is a new patient-reported outcome measure of treatment response, which has been shown to have face validity. What does this study add? • The VNS has good construct validity, acceptability and interpretability, supporting its inclusion as a patient-reported measure of the cosmetic acceptability of treat- ment response in vitiligo trials. © 2015 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists. 386 British Journal of Dermatology (2016) 174, pp386–394 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.