Skin nontumor
Pigmentary disorders
Vitiligo


Topic Completed: 1 August 2011

Minor changes: 28 August 2020

Copyright: 2002-2020, PathologyOutlines.com, Inc.

PubMed Search: Vitiligo [title] skin

Mowafak Hamodat, M.B.Ch.B., M.Sc.
Christopher S. Hale, M.D.
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Cite this page: Hamodat M, Hale CS. Vitiligo. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumorvitiligo.html. Accessed October 26th, 2020.
Definition / general
  • Partial or complete loss of pigment producing melanocytes within the epidermis (Wikipedia, eMedicine)
Epidemiology
  • Affects 1% of world’s population; more noticeable in dark skinned individuals
  • Usually hands / wrists, axilla, perioral, periorbital, anogenital skin
Sites
  • Focal: only a few areas
  • Segmented: one side of the body only
  • Generalized: most common, both sides of body
  • Trichrome: patient has three shades of skin color
Clinical features
  • Asymptomatic, flat, well-demarcated zones of pigment loss
  • Autoimmune disorder associated with pernicious anemia, Addison’s disease, Hashimoto’s thyroiditis
  • Perilesional skin up to 5 cm from vitiligo spot is still lighter than normal (Photodermatol Photoimmunol Photomed 2008;24:314)
  • Associated with polymorphisms in COX2 gene (J Dermatol Sci 2009;53:176), mutations of autoimmune regulator gene (Br J Dermatol 2008;159:591)
  • May cause severe psychological distress
  • May worsen with local trauma (cuts, scrapes, burns, Koebner phenomenon)
  • Decreased risk for melanoma and nonmelanoma skin cancer (Br J Dermatol 2013;168:162)
Treatment
Clinical images

Images hosted on other servers:

Various images

Marginal inflammatory

Segmental


Nonsegmental

Hands

Autologous epidermal graft using suction blister

Microscopic (histologic) description
  • Difficult to diagnose by histology; decreased melanocytes (use S100 or MelanA and control biopsy from adjacent normal skin)(Am J Dermatopathol 2008;30:112)
  • At advancing border, melanocytes may be increased in size with an increased number of dendrites; occasionally lymphocytes are present in this region, particularly if an inflammatory border is present; epidermotropic lymphocytes may form small Pautrier-like collections in the basal layer, with an associated perivascular infiltrate of mononuclear cells involving the superficial plexus and some superficial edema
  • Focal spongiosis may be present in marginal areas
  • Degenerative changes have also been reported in nerves and sweat glands
  • Langerhans cells are usually increased
  • Melanocytes are always reduced more in vitiligo than they are in nevus depigmentosus
Electron microscopy description
Differential diagnosis
  • Leukoderma: chemical, melanoma related, scleroderma related; acquired condition with localized loss of skin pigmentation associated with inflammatory skin conditions, burns, intralesional steroid injections, postdermabrasion (Wikipedia)
  • Oculocutaneous albinism: melanocytes present, but no melanin due to defect in tyrosinase enzyme or melanogenesis
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