Oral communication, CS11 / C48
Official XXIst International Pigment Cell Conference website - 21-24 Sept 2011, Bordeaux - France | updated: September 04 2011
Histopathological staging of vitiligo lesions- Implications for treatment
SPEAKER | S.K. Attili #whois submiter ? |
AUTHOR(s) | S.K. Attili, V.R. Attili |
BACKGROUND: Vitiligo is largely perceived as an invisible dermatosis with no significant histopathological findings. Basing on our experience of studying vitiligoid lesions over the last 8 years, we propose that histopathology of vitiligo has an important role in the diagnosis as well as its treatment. METHODS: Histopathological features of vitiligo lesions in routine haematoxylin and eosin stained sections from 280 patients were analyzed RESULTS: Three primary patterns were identified common to focal, segmental as well as the generalized disease: 1. lichenoid Inflammatory lesions (51%) or post-inflammatory changes characterized by a disarrayed dermo-epidermal interface with loss of melanocytes and mild perivascular lymphocytic infiltrates with melanophages in papillary dermis 2. stable depigmentation (42%) with absence of melanocytes as well as cellular infiltrates with minimal structural alterations 3. and long standing lesions with mild atrophy/ sclerosis (7%) associated with gross structural alterations. CONCLUSIONS: These three patterns are proposed as evolutionary stages in the histopathogenesis of vitiligo which can also be used for selecting appropriate treatment protocols. Microinflammatory lesions are likely to respond to oral steroids/ immunosupressants by arresting the disease progression. Stable lesions can respond better to treatments aimed at migration of dermal melanocytes to the depleted epidermis. Absence of cellular infiltrates in a biopsy can be an objective method to identify stability for vitiligo surgery as against an unreliable patient history. In longstanding lesions with adnexal destruction, melanocyte migration from the depleted dermal reservoir is unlikely and various surgical grafting techniques can be considered.