Characteristics of vitiligo

Vitiligo is a syndrome characterized by acquired loss of pigmentation in a usually symmetrical but 'spotty" distribution, commonly involving the central face and lips, genitalia, hands and extremities. Pigmentation in the skin is produced by melanin, a hetero-polymer synthesized in melanocytes by a complex biochemical pathway controlled by the rate-limiting enzyme tyrosinase. Melanin is packaged in melanosomes which are transferred to keratinocytes to provide broad-spectrum photoprotection to the skin.

Jarrett and Szabo first proposed that vitiligo was characterized by two stages that might be sequential: type I vitiligo with decreased melanocyte tyrosinase activity, and type II vitiligo in which melanocytes were destroyed. In established vitiligo, cells with ultrastructural and immunohistochemical features of melanocytes are lost from the basal layer of the epidermis. Vacuolar damage to both basal layer melanocytes and keratinocytes can be found in association with infiltrates composed of monocytes and lymphocytes. Melanocytes and keratinocytes in the active border of vitiligo lesions show increased ICAM-1 expression, suggesting local effect of cytokines and potentiation of immunologic cytotoxicity.

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