VITILIGO WITH RAISED INFLAMMATORY BORDERS - INVOLVEMENT OF T-CELL IMMUNITY AND KERATINOCYTES EXPRESSING MHC CLASS-II AND ICAM-1 MOLECULES

Vitiligo with raised inflammatory borders, which is also called inflam matory vitiligo, is a rare disorder in which developing vitiliginous l esions are surrounded by an elevated, scaling border. Several studies have shown that in the elevated borders, melanocytes are-degenerated b y the adhesion of lymphocytes that infiltrate into the epidermis. A 61 -year-old Japanese man was diagnosed as having vitiligo with raised in flammatory borders on his left elbow, which had been preceded by a 5-y ear-history of ordinary, nor-raised vitiligo on his trunk and limbs. T he histologic and immunohistochemical studies of the border revealed t hat CD4(+) CD45RO(+) T cells and a smaller, but still substantial numb er of. CD8(+) T cells, had invaded the epidermis with the appearance o f a lichenoid tissue reaction: Keratinocytes in the border bore HLA-DR and ICAM-1 molecules, whereas these antigens were not expressed eithe r side of the elevated border. In addition, S-100 protein-positive Lan gerhans cells disappeared inside the border. These findings suggested that centrifugally enlarging inflammation in which T cells attack mela nocytes and Langerhans cells in the presence of immunologically-stimul ated keratinocytes results in the formation of vitiligo within the ele vated border.