Background The term trichrome vitiligo describes lesions that have a tan zo
ne of varying width between normal and totally depigmented skin, which exhi
bits an intermediate hue. However, the pathogenesis and the histopathologic
characteristics of trichrome vitiligo are unknown.
Objective: Our purpose was to investigate the clinical and histopathologic
characteristics and the pathogenesis of trichrome vitiligo.
Methods: Four punch biopsy specimens were taken from 21 patients with trich
rome vitiligo; they were from vitiliginous skin, light brown skin, perilesi
onal normal skin, and normal skin as far as 5 cm from the nearest vitiligo
spot. The sections were stained with hematoxylin-eosin; in selected cases,
we performed immunohistochemical staining with S-100 protein and CD1a.
Results: Trichrome vitiligo occurred most frequently on the trunk in active
vitiligo vulgaris. Focal vacuolar degeneration of the basal cell layer and
mild inflammatory cell infiltration of the epidermis and dermis were more
prominent in light brown skin and perilesional normal skin than in vitiligi
nous skin and normal skin. The number of melanocytes was decreased in light
brown skin compared with perilesional normal skin (P < .05) and in vitilig
inous skin compared with light brown skin (P < .05); a few melanocytes were
observed even in skin affected by trichrome vitiligo. The number of Langer
hans cells was increased in the epidermis of light brown skin and perilesio
nal normal skin compared with vitiliginous and normal skin (P < .05). PUVA
therapy yielded excellent repigmentation.
Conclusion: Trichrome vitiligo is a variant of active vitiligo. The changes
of melanocytes, keratinocytes, and Langerhans cells may be involved in the
pathogenesis of depigmentation in trichrome vitiligo.