Vitiligo: a review of some facts lesser known about depigmentation

Abstract

Vitiligo is a disorder that causes the destruction of melanocytes. It has three important factors underlying this destruction. The depigmented skin has many aberrant functions such as a muted response to contact allergens, a phenomenon also seen in mice that depigment. The white skin of those with vitiligo does not form non-melanoma skin cancers although the white skin of albinos, which has a similar color as vitiligo, is highly susceptible to skin cancer.

Keywords: Vitiligo; albinos; contact allergen; non-melanoma skin cancer.

Figure 1

Depigmentation of the fingers and dorsum of the hands, classical, early manifestations of vitiligo

Figure 2

Depigmentation of the feet, typical early manifestation of vitiligo

Figure 3

Depigmentation around the eyes (partially blocked), the nares and mouth, all classical and early manifestations of bilateral vitiligo

Figure 4

Extensive depigmentation of a woman which illustrates the symmetrical distribution of classical bilateral vitiligo

Figure 5

Unilateral (segmental) vitiligo affecting one side of the face of a young boy. Note that the depigmentation does not correspond to a dermatome

Figure 6

Unilateral depigmentation (segmental vitiligo) affecting the neck of a woman. Note the very similar distribution of depigmentation in the two men pictured in Figures 7 and 8

Figure 7

Unilateral depigmentation (segmental vitiligo) of the neck of a man which is similar to the depigmentation seen in Figures 6 and 8

Figure 8

Unilateral depigmentation (segmental vitiligo) on the neck of a man with a distribution similar to that in Figures 6 and 7

Figure 9

Nevus depigmentosus on the neck of a boy. The pigmentary abnormality was present at birth in the patient

Figure 10

Nevus depigmentosus on the neck of a man. The pigmentary abnormality was present at birth in the patient

Figure 11

Unilateral depigmentation (segmental vitiligo) on the anterior chest and upper part of the right arm in a young woman. The distribution of pigment loss is very similar in this patient and the one given in Figure 12

Figure 12

Unilateral depigmentation (segmental vitiligo) on the anterior chest and upper part of the right arm in a girl. The distribution of pigment loss is very similar in this patient and the one shown in Figure 11

Figure 13

A nevus depigmentosus in a young girl with a distribution of pigment loss similar to the unilateral vitiligo seen in Figures 11 and 12

Figure 14

An Indian woman with veloce vitiligo. She lost almost all of her pigmentation on the skin and hair over a period of some months

Figure 15

The epidermis is composed of three main cell types that work together like a troika

Figure 16

A woman treated with monobenzone, who developed a contact allergy. The dermatitis is exclusively confined to the pigmented skin

Figure 17

A man treated with monobenzone, who developed a contact allergy. The dermatitis is exclusively confined to the pigmented skin

Figure 18

Mice with mi^vit/mi^vit gene. The mouse on the left has a piebald band on the leg but a normal pigmented pelage in early life. The mouse on the right is undergoing depigmentation with loss of melanocytes from the epidermis and hair follicles

Figure 19

The neck of an African woman who had vitiligo for over 20 years. She was a farmer and worked in the sun daily. Note the elastosis of the neck, but the normal overlying white epidermis

Figure 20

The hands of the African woman shown in Figure 19, who had vitiligo for over 20 years. She was a farmer and worked in the sun daily

Figure 21

The arms of a woman with piebaldism (c-kit). She has marked sun damage and many actinic keratoses, mostly in the depigmented patches on her arms

Figure 22

The leg shows repigmentation from the hair follicles

Figure 23

The leg has all white hairs and no repigmentation is visible except in one spot (arrows and circle)