A Case of Inflammatory Vitiligo: DISCUSSION
Although vitiligo is a common pigmentary disorder, inflammatory vitiligo is an unusual occurrence. Since the initial description of inflammatory vitiligo, only about 20 cases have been identified via a review of the literature. Among them, 3 reports were of inflammatory vitiligo with erythematous, scaly plaques, as in our patient .
This unique form of vitiligo is also considered to be an accentuated reaction of vitiligo, and provides evidence for the involvement of cellular immunity in the pathogenesis of vitiligo. The pathogenesis of vitiligo is still a matter of debate, but the autoimmune hypothesis is considered to be the major factor, and both humoral and cellular immunity has been considered. Histologically, an infiltrate of skin-homing cytotoxic T-cells expressing granzyme/perforin is often found close to the remaining melanocytes in marginal skin from progressing lesions of generalized vitiligo. An histology and immu- nophenotypic study of vitiligo on inflammatory- raised erythema was reported by LePoole et al and the erythematous margin in our case showed acanthosis, focal vacuolar alteration of the basal layer associated with exocytosis and superficial papillary and perivascular lymphocytic infiltrate, which mainly consisted of T-cells, and a decrease in the number of melanocytes. These results suggest that our case might be an accentuated form of vitiligo and that T cell-medicated cytotoxicity may be involved in its pathogenesis. Histopathologic findings could rule out atrophic lichen planus and parapsoriasis. The main risk in the diagnosis of inflammatory vitiligo is to rule out a hypopigmented variant of MF. In our case, the erythematous raised border surrounding hypopigmented patches, the loss of melanocytes, exocytosis with spongiosis and absence of atypical lymphocytes favoured the diagnosis of inflammatory vitiligo. kamagra tablets
To conclude, we present the first case of inflammatory vitiligo in Korea.
