Lichenoid inflammation in vitiligo - a clinical and histopathologic review of 210 cases

Background '"Inflammatory vitiligo" cases with clear lichenoid infiltrates have been reported. However, the inflammatory nature of common vitiligo has not gained wide acceptance because of its benign appearance and scanty cellular infiltrates. We have observed in our patients a few lesions with mild erythema, scaling and marginal hyperpigmentation which were suspected to be inflammatory. This study was conducted to assess the histological features and prevalence of such marginally active lesions, in comparison with common vitiligo. Methods Two hundred and ten consecutive new cases of vitiligo seeking treatment for the first time were included in this study. Clinical lesions were carefully examined and biopsies were taken in all cases. Biopsies were also taken from pigmented skin 3 cm away from the vitiligo lesion in 20 cases and normal pigmented skin over the contralateral side in 20. Results Marginally active lesions with erythema, scaling and hyperpigmentation were identified in 27 patients (13%). Lymphocytic infiltration of dermo-epidermal interface was observed in 89% of these cases which was clearly lichenoid in 59%. Similar lichenoid infiltrates were also seen in 50% of pigmented skin samples 3 cm away from the lesion and 23% of common macular vitiligo lesions. Conclusion Vitiligo is an inflammatory disease that with development involves a lichenoid tissue reaction.