A Case of Inflammatory Vitiligo: CASE REPORT
A 56-year-old male resented with a 1-year history of hypopigmented lesions on the trunk and extremities. On physical examination, there were variable sized hypopigmented patches on the buttocks and trunk, both under natural light and by Wood lamp examination (Fig. la). On the thigh, there were several centrally-hypopigmented patches with a discrete, elevated, scaly, erythematous rim (Fig. lb). The patient described that at first, the lesions on the abdomen and buttocks also showed an elevated, scaly, erythematous rim but the lesions had then subsequently turned into completely depigmented patches. There was no significant past medical or family history. Intermittent mild itching was noted. A KOH preparation of scales from the thigh and ankle showed negative findings. Laboratory evaluation including a complete blood count, ANA, and VDRL were within normal limits. Given the loss of pigment on the buttocks and trunk, inflammatory vitiligo was the leading diagnosis. However, the differential diagnosis included hypopigmented mycosis fungoides.
Fig. 1 (a) Variable-sized, hypopigmented patches with scalloped borders on the buttocks, (b) Several centrally-hypopigmented patches with a discrete, elevated, scaly erythematous rim on the thigh.
Three biopsy specimens were obtained from the thigh, one each from the normally- pigmented skin, the erythematous border, and the depigmented skin. Histopathologically, the biopsy specimen from the erythematous border showed mild acanthosis, mild spongiosis and focal vacuolar alteration of the basal layer associated with exocytosis and superficial papillary and perivascular lymphocytic infiltrate (Fig. 2a). No atypical lymphocytes were noted. An immunohistochemical stain for melanocytes, NKI-beteb, showed a markedly-decreased number of melanocytes in the epidermis and in some foci, they were completely absent (Fig. 2b). Fontana- Masson staining for melanin revealed diminished melanin pigment. CD3 staining revealed a large number of T cells, and they were mainly concentrated along the basal layer. A biopsy specimen from depigmented skin showed a very sparse superficial perivascular lymphocytic infiltrate (Fig. 2c). NKI- beteb staining showed a complete absence of melanocytes in the epidermis (Fig. 2d). Fontana-Masson staining revealed no melanin pigment in the basal cell layer. Histological examination from normal skin showed no histopathological abnormalities (Fig. 2e). NKI-beteb staining revealed a normal number and distribution of melanocytes (Fig. 2f). cialis super active
Fig. 2. (a) Erythematous border showed exocytosis, focal vacuolar alteration of the basal layer and superficial inflammatory infiltrates, (b) Staining for melanocytes of the erythematous border showed a markedly- decreased number of melanocytes in the epidermis, and in some foci, they were completely absent, (c) Depigmented skin showed very sparse, superficial perivascular infiltrates, (d) Staining for melanocytes of depigmented skin showed a complete absence of melanocytes in the epidermis, (e) Histological examination from normal skin showed no histopathological abnormalities, (f) Staining for melanocytes of normal skin revealed a normal number and distribution of the melanocytes (a,c,e: H & E; original magnifications: x 200, b,d,f: NKI- beteb stain; original magnifications: x 200).
