Activity status in vitiligo lesions: diagnostic clues

Background Assessment of the activity status of vitiligo lesions is essential to make appropriate therapeutic decisions. Up till now, the activity of vitiligo is determined by the appearance of new lesions, which is mostly provided by patients’ words. Objective The objective of this study was to provide clues for dermatologists to determine the activity status in vitiligo lesions. Patients and methods This prospective analytical study included 157 nonsegmental vitiligo cases in addition to regressing vitiligo in 10 patients under treatment. Dermatological examination was carried out. Skin biopsy specimens were taken from the margin of active and stable vitiligo lesions and stained with hematoxylin and eosin and Masson-Fontana. Immunohistochemical examination was performed for 20 active vitiligo lesions for CD3, CD20, and CD68. Results Active vitiligo patches showed depigmented convex festooning edges, pigmented spikes, poorly defined borders, a reticulated or trichrome pattern, hypopigmentation, an inflammatory raised edge or a quadrichrome pattern in the following descending frequencies: 84.7, 82.4, 76.5, 55.3, 36.5, 17.6, 1.2, and 1.2%. Meanwhile, all stable vitiligo patches showed sharply demarcated borders. All regressing vitiligo patches had pigmented convex festooning edges and depigmented spikes. Histopathologically, active vitiligo lesions showed mononuclear cells (sparse, moderate or marked levels in 24.7, 65.9, or 9.4% of the lesions), epidermotropism in 100%, vacuolated keratinocytes in 78.8% and melanophages in 72.9% of the cases. All active vitiligo lesions were positive for CD3 and CD68 and negative for CD20. Conclusion The study suggested that the morphology of the edge and the color of the vitiliginous patch can reflect the actual activity of the disease. Histopathologically, attack of epidermal keratinocytes by inflammatory infiltrates may be considered as a diagnostic clue for disease activity.