Vitiligo

Synonyms: Achroma vitiligo.

Clinical Presentation (Fig. 12A):

■ Depigmented macules and patches

■ Localized, segmental, or widespread; often symmetric

■ Association, episodically, with alopecia areata, Hashimoto's thyroiditis, diabetes mellitus, Addison's disease, lupus erythematosus, myasthenia gravis, primary biliary cirrhosis, or Vogt-Koyanagi-Harada's syndrome

Histopathology (Figs. 12B and C):

■ Sparse superficial perivascular infiltrate of lymphocytes

■ Few lymphocytes sprinkled in the lower half of the epidermis sometimes

■ Melanocytes at the dermoepidermal junction decreased markedly in number or absent entirely

■ Melanin in the epidermis decreased in amount

Clinicopathologic Correlation:

Clinical Feature

Pathologic Feature

Hypopigmented macules

Absence of melanocytes

Differential Diagnosis:

Pityriasis Alba

Hypopigmented Scar

Perivascular dermatitis, lymphocytes monopolize

No or sparse infiltrate, collagen bundles arranged horizontally

Melanocytes present in the epidermis

Melanocytes present in the epidermis

Pathophysiology:

■ The disorder is thought to be an autoimmune disease.

■ Antimelanocyte antibodies are present in the serum of patients.

References:

1. Gauthier Y, Cario Andre M, Taieb A. A critical appraisal of vitiligo etiologic theories. Is melanocyte loss a melanocytorrhagy? Pigment Cell Res 2003; 16(4):322-332.

2. Gokhale BB, Mehta LN. Histopathology of vitiliginous skin. Int J Dermatol 1983; 22:477-480.

3. Hann SK, Park YK, Lee KG, Choi EH, Im S. Epidermal changes in active vitiligo. J Dermatol 1992; 19:217-222.

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